Provider Demographics
NPI:1043482821
Name:DAKE, NANCY (LMT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DAKE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66105 HUNTER RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-5144
Mailing Address - Country:US
Mailing Address - Phone:541-963-7812
Mailing Address - Fax:
Practice Address - Street 1:66105 HUNTER RD
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-5144
Practice Address - Country:US
Practice Address - Phone:541-963-7812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14665172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist