Provider Demographics
NPI:1891348751
Name:LE NGUYEN, LUCIE I (MA60973652)
Entity Type:Individual
Prefix:MRS
First Name:LUCIE
Middle Name:
Last Name:LE NGUYEN
Suffix:I
Gender:F
Credentials:MA60973652
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 SE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-5818
Mailing Address - Country:US
Mailing Address - Phone:425-524-5569
Mailing Address - Fax:
Practice Address - Street 1:680 NW GILMAN BLVD STE A
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2454
Practice Address - Country:US
Practice Address - Phone:425-427-6562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60973652225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60973652OtherLICENSED MASSAGE THERAPIST