Provider Demographics
NPI:1295958080
Name:IRVINE, JANET ANN (LMP)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:ANN
Last Name:IRVINE
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 1:430 E LAURIDSEN BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-7978
Mailing Address - Country:US
Mailing Address - Phone:360-457-7576
Mailing Address - Fax:360-452-8079
Practice Address - Street 1:430 E LAURIDSEN BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7978
Practice Address - Country:US
Practice Address - Phone:360-457-7576
Practice Address - Fax:360-452-8079
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009699225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0112558OtherWA L & I PROVIDER NUMBER