Provider Demographics
NPI:1346368156
Name:HERBAN OASIS
Entity Type:Organization
Organization Name:HERBAN OASIS
Other - Org Name:DIANE YOUNG LMT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNERPRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:509-953-1121
Mailing Address - Street 1:4611 N VISTA RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99212-1728
Mailing Address - Country:US
Mailing Address - Phone:509-953-1121
Mailing Address - Fax:509-928-5863
Practice Address - Street 1:4611 N VISTA RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99212-1728
Practice Address - Country:US
Practice Address - Phone:509-953-1121
Practice Address - Fax:509-928-5863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007613225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA101305OtherLABOR & INDUSTRIES