=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699091967
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY EMBREE LMP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2010
-----------------------------------------------------
Last Update Date | 10/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3207 N ARGONNE RD
-----------------------------------------------------
City | SPOKANE VALLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99212-2061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-921-1317
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5205 N BOLIVAR RD
-----------------------------------------------------
City | SPOKANE VALLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99216-1483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-953-1720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA60106450
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------