Provider Demographics
NPI:1770603581
Name:MYHRES, LINDA RAE (LMT)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:RAE
Last Name:MYHRES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:R
Other - Last Name:MYHRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:161 FARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-9716
Mailing Address - Country:US
Mailing Address - Phone:425-931-8621
Mailing Address - Fax:
Practice Address - Street 1:106 W LAURIDSEN BLVD
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7752
Practice Address - Country:US
Practice Address - Phone:425-931-8621
Practice Address - Fax:425-931-8621
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022663174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA210186OtherSTATE L&I BILLING ID