Provider Demographics
NPI:1720561640
Name:NELSON, ANNE KATHERYN (LMT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:KATHERYN
Last Name:NELSON
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 1:9901 257TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-8410
Mailing Address - Country:US
Mailing Address - Phone:507-202-6621
Mailing Address - Fax:
Practice Address - Street 1:17528 MERIDIAN E STE 207
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6286
Practice Address - Country:US
Practice Address - Phone:253-445-9030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist