Provider Demographics
NPI:1265731459
Name:CERNA, CHARLOTTE MERCEDES (LMP)
Entity type:Individual
Prefix:MISS
First Name:CHARLOTTE
Middle Name:MERCEDES
Last Name:CERNA
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 1:319 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5767
Mailing Address - Country:US
Mailing Address - Phone:253-850-9780
Mailing Address - Fax:253-850-6445
Practice Address - Street 1:319 WASHINGTON AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5767
Practice Address - Country:US
Practice Address - Phone:253-850-9780
Practice Address - Fax:253-850-6445
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60214343225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist