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NPI Code Detail

MEDICARE: DANNETTE LYNN ENEVOLDSEN

MEDICARE: DANNETTE LYNN ENEVOLDSEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistMA00017083WA

General Provider Information

NPI Number : 1063537496
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANNETTE LYNN ENEVOLDSEN
Provider Business Mailing Address
First Line : 1913 HILL PL
Second Line :
City : SNOHOMISH
State : WA
Zip : 98290-1440
Country : US
Telephone Number : 425-387-1962
Fax Number :
Provider Business Practice Location Address
First Line : 902 E MAPLE ST
Second Line :
City : ARLINGTON
State : WA
Zip : 98223-1634
Country : US
Telephone Number : 360-435-9338
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/08/2007

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Directions to “ DANNETTE LYNN ENEVOLDSEN ” Practice Location

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