MEDICARE: LANA DICKSON

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	MA00011221	WA

General Provider Information

NPI Number	:	1447219175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANA DICKSON

Provider Business Mailing Address
First Line	:	16500 SE 15TH ST STE 160
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98683-9666
Country	:	US
Telephone Number	:	360-718-7944
Fax Number	:

Provider Business Practice Location Address
First Line	:	16500 SE 15TH ST STE 160
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98683-9666
Country	:	US
Telephone Number	:	360-718-7944
Fax Number	:

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	06/26/2008

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Directions to “ LANA DICKSON ” Practice Location

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