Provider Demographics
NPI:1689968034
Name:WINJE, AMANDA LEE (LMP)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:LEE
Last Name:WINJE
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 1:129 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-9668
Mailing Address - Country:US
Mailing Address - Phone:509-671-1151
Mailing Address - Fax:509-447-9986
Practice Address - Street 1:129 S UNION AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-9668
Practice Address - Country:US
Practice Address - Phone:509-671-1151
Practice Address - Fax:509-447-9986
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60219373225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist