Provider Demographics
NPI:1083908354
Name:NESSMITH, HEATHER MAE (LMP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MAE
Last Name:NESSMITH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3713 NW 121ST CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2061
Mailing Address - Country:US
Mailing Address - Phone:360-600-3165
Mailing Address - Fax:
Practice Address - Street 1:5500 NE 109TH CT
Practice Address - Street 2:SUITE L
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6176
Practice Address - Country:US
Practice Address - Phone:360-828-5411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017959225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist