Provider Demographics
NPI:1831401439
Name:NASH RENEE', JODI (LMP)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:
Last Name:NASH RENEE'
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 1:208 28TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-1236
Mailing Address - Country:US
Mailing Address - Phone:253-219-4970
Mailing Address - Fax:253-861-8941
Practice Address - Street 1:208 28TH AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-1236
Practice Address - Country:US
Practice Address - Phone:253-219-4970
Practice Address - Fax:253-861-8941
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011226225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist