MEDICARE: MRS. NANCY ANN SEREJCH 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	MA00023810	WA

General Provider Information

NPI Number	:	1205014123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY ANN SEREJCH LMP

Provider Business Mailing Address
First Line	:	7520 30TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-3327
Country	:	US
Telephone Number	:	206-910-3356
Fax Number	:	484-993-3603

Provider Business Practice Location Address
First Line	:	9001 35TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-3327
Country	:	US
Telephone Number	:	206-910-3356
Fax Number	:	484-993-3603

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

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	03/21/2011

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