Provider Demographics
NPI:1407175409
Name:BUELL, ANNA MAE (LMP)
Entity Type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:MAE
Last Name:BUELL
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 1:11921 CANYON RD E STE A
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-4403
Mailing Address - Country:US
Mailing Address - Phone:253-254-1619
Mailing Address - Fax:
Practice Address - Street 1:11921 CANYON RD E
Practice Address - Street 2:SUITE A
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-4403
Practice Address - Country:US
Practice Address - Phone:253-254-1619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-31
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60142126225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60142126OtherMASSAGE LICENSE #MA60142126