Provider Demographics
NPI:1811100191
Name:BOSER, ANITA LYNN (LMP, CHP)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:LYNN
Last Name:BOSER
Suffix:
Gender:F
Credentials:LMP, CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27404 SE 154TH PL
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-7332
Mailing Address - Country:US
Mailing Address - Phone:425-765-2713
Mailing Address - Fax:
Practice Address - Street 1:545 RAINIER BLVD N STE 6
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2806
Practice Address - Country:US
Practice Address - Phone:425-765-2713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA15897225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA15897OtherMASSAGE LICENSE
WA0155289OtherLABOR & INDUSTRIES