Provider Demographics
NPI:1821211004
Name:ABEL, JEROME DEAN (LMT, NCTMB)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:DEAN
Last Name:ABEL
Suffix:
Gender:M
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 W 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-4401
Mailing Address - Country:US
Mailing Address - Phone:509-458-0490
Mailing Address - Fax:
Practice Address - Street 1:9419 N NEWPORT HWY
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1243
Practice Address - Country:US
Practice Address - Phone:509-467-8176
Practice Address - Fax:509-467-1368
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC10054879376K00000X
WAMA00021808225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA80869OtherAWHN