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General NPI Number Information
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NPI Number | 1215150586
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Entity Type | Individual
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Provider Name | SHEILA RENE HANSEN LMP
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9257 SILVERDALE LOOP RD NW
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City | SILVERDALE
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State | WA
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Zip | 98383-8327
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Country | US
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Telephone | 360-698-9039
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Fax | 360-308-9752
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Provider Business Mailing Address
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Address Line | PO BOX 447
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City | BURLEY
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State | WA
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Zip | 98322-0447
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Country | US
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Telephone | 360-698-9039
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Fax | 360-308-9752
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00006506
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License Number State | WA
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