Provider Demographics
NPI:1275021719
Name:NOLTE, KARLA JANETTE (LMT)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:JANETTE
Last Name:NOLTE
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 1:15316 NE 80TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-3487
Mailing Address - Country:US
Mailing Address - Phone:503-997-0568
Mailing Address - Fax:
Practice Address - Street 1:4400 NE 77TH AVE STE 275
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6857
Practice Address - Country:US
Practice Address - Phone:360-768-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60745365225700000X
OR22952225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist