Healthcare Provider Details

I. General information

NPI: 1982936183
Provider Name (Legal Business Name): JANET CLAIRE ATWATER L.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W MAIN ST SUITE 202
WALLA WALLA WA
99362-2872
US

IV. Provider business mailing address

30 W MAIN ST SUITE 202
WALLA WALLA WA
99362-2872
US

V. Phone/Fax

Practice location:
  • Phone: 509-526-0655
  • Fax: 509-526-6944
Mailing address:
  • Phone: 509-526-0655
  • Fax: 509-526-6944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00012808
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: