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General NPI Number Information
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NPI Number | 1760205967
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Entity Type | Individual
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Provider Name | CENISA MIER MA61626227
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Gender | Female
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 655 GOLF CLUB PL SE
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City | LACEY
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State | WA
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Zip | 98503-1088
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Country | US
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Telephone | 360-352-8896
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Fax |
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Provider Business Mailing Address
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Address Line | 2834A MONFORE DR # A
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City | JOINT BASE LEWIS MCCHORD
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State | WA
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Zip | 98433-1048
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Country | US
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Telephone | 832-318-9227
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Fax |
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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 | MA61626227
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License Number State | WA
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