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General NPI Number Information
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NPI Number | 1366680993
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Entity Type | Individual
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Provider Name | JENNIFER LYNNE NANIE L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 02/04/2009
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Provider Practice Location Address
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Address Line | 1012 TREVITT ST
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City | THE DALLES
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State | OR
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Zip | 97058-1463
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Country | US
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Telephone | 541-296-6495
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Fax | 541-296-6497
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Provider Business Mailing Address
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Address Line | 1012 TREVITT ST
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City | THE DALLES
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State | OR
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Zip | 97058-1463
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Country | US
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Telephone | 541-296-6495
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Fax | 541-296-6497
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 14616
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License Number State | OR
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