MEDICARE: NANCY FARMER LMP

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
1	225700000X	Massage Therapist	MA60244635	WA

General Provider Information

NPI Number	:	1063857795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY FARMER LMP

Provider Business Mailing Address
First Line	:	2721 CEDAR RD
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-8475
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2721 CEDAR RD
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-8475
Country	:	US
Telephone Number	:	425-330-1639
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	05/08/2013

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