Provider Demographics
NPI:1164601654
Name:MILLER, LYNETTE JEAN (LMP)
Entity Type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:JEAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:LYNETTE
Other - Middle Name:JEAN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 SOUTH 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901
Mailing Address - Country:US
Mailing Address - Phone:509-249-8704
Mailing Address - Fax:509-249-8706
Practice Address - Street 1:111 SOUTH 3RD STREET
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901
Practice Address - Country:US
Practice Address - Phone:509-249-8704
Practice Address - Fax:509-249-8706
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024761225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist