Provider Demographics
NPI:1720392483
Name:LOVELESS, AMBER NICHOLE (LMT, CMMT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICHOLE
Last Name:LOVELESS
Suffix:
Gender:F
Credentials:LMT, CMMT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:NICHOLE
Other - Last Name:DRIESEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4945 ELM ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2620
Mailing Address - Country:US
Mailing Address - Phone:425-268-6289
Mailing Address - Fax:
Practice Address - Street 1:1920 100TH ST SE
Practice Address - Street 2:A3
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208
Practice Address - Country:US
Practice Address - Phone:425-268-6289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021847225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist