Provider Demographics
NPI:1669036554
Name:WREN, ARIANA FELINE (LMT)
Entity Type:Individual
Prefix:
First Name:ARIANA
Middle Name:FELINE
Last Name:WREN
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 1:11314 SE 162ND ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5230
Mailing Address - Country:US
Mailing Address - Phone:813-808-1440
Mailing Address - Fax:
Practice Address - Street 1:11314 SE 162ND ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5230
Practice Address - Country:US
Practice Address - Phone:813-808-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60646368225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60646368Medicaid