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NPI Code Detail

MEDICARE: MS. NICOLE M SMITH LMP

MEDICARE: MS. NICOLE M SMITH 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
1225700000XMassage TherapistMA00010064WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14324SMOTHERWAREGENCE BS
28930149OTHERWACRIME VICTIMS
3181042OTHERWADEPT OF L&I

General Provider Information

NPI Number : 1871586073
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NICOLE M SMITH LMP
Provider Business Mailing Address
First Line : PO BOX 731269
Second Line :
City : PUYALLUP
State : WA
Zip : 98373-0060
Country : US
Telephone Number : 253-840-6448
Fax Number : 253-840-6340
Provider Business Practice Location Address
First Line : 17650 140TH AVE SE
Second Line :
City : RENTON
State : WA
Zip : 98058-6814
Country : US
Telephone Number : 425-430-0700
Fax Number : 425-430-0710
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 07/08/2007

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Directions to “ MS. NICOLE M SMITH LMP” Practice Location

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