Provider Demographics
NPI:1134459415
Name:DAUENHAUER, KIM RENE' (LMP)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:RENE'
Last Name:DAUENHAUER
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 1:7200 W. NOBHILL BLVD.
Mailing Address - Street 2:SUITE 11
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908
Mailing Address - Country:US
Mailing Address - Phone:509-966-2933
Mailing Address - Fax:
Practice Address - Street 1:7200 W. NOBHILL BLVD.
Practice Address - Street 2:SUITE 11
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908
Practice Address - Country:US
Practice Address - Phone:509-966-2933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60125657225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist