Provider Demographics
NPI:1790084358
Name:NATHAN, WENDY (LMP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:NATHAN
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 1:4537 48TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4039
Mailing Address - Country:US
Mailing Address - Phone:206-932-4409
Mailing Address - Fax:
Practice Address - Street 1:509 OLIVE WAY STE 755
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1773
Practice Address - Country:US
Practice Address - Phone:206-264-9400
Practice Address - Fax:206-264-4939
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00012356225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist