Provider Demographics
NPI:1972904449
Name:SOM, CARMEN ANDREA (LMP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:ANDREA
Last Name:SOM
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:ANDREA
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:416 9TH ST.
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-1503
Mailing Address - Country:US
Mailing Address - Phone:360-393-0578
Mailing Address - Fax:509-662-2161
Practice Address - Street 1:3164 MONTEREY DR
Practice Address - Street 2:
Practice Address - City:MALAGA
Practice Address - State:WA
Practice Address - Zip Code:98828-9731
Practice Address - Country:US
Practice Address - Phone:360-393-0578
Practice Address - Fax:509-884-2363
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60301063225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist