Provider Demographics
NPI:1538298120
Name:NORDLUND, CYNTHIA JEAN (LMP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:JEAN
Last Name:NORDLUND
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7209 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-5945
Mailing Address - Country:US
Mailing Address - Phone:253-756-8064
Mailing Address - Fax:253-627-7909
Practice Address - Street 1:722 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-756-8064
Practice Address - Fax:253-627-7909
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006695225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist