Provider Demographics
NPI:1699367854
Name:LUSIGNAN, GINA D
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:D
Last Name:LUSIGNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4317 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-4334
Mailing Address - Country:US
Mailing Address - Phone:509-551-3231
Mailing Address - Fax:509-735-9868
Practice Address - Street 1:8131 W KLAMATH CT STE H
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5251
Practice Address - Country:US
Practice Address - Phone:509-736-5456
Practice Address - Fax:509-735-9868
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61127571225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA61127571OtherMASSAGE THERAPIST