Provider Demographics
NPI:1841489523
Name:STEVENS, DANIELLE NICOLE (LMT)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:NICOLE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:NICOLE
Other - Last Name:CARRILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:107 S 7TH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3385
Mailing Address - Country:US
Mailing Address - Phone:509-453-1420
Mailing Address - Fax:509-453-1453
Practice Address - Street 1:107 S 7TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3385
Practice Address - Country:US
Practice Address - Phone:509-453-1420
Practice Address - Fax:509-453-1453
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0195427OtherLABOR & INDUSTRIES
WA365096198Other365096198
WAMA00020706OtherMASSAGE PRACTIONER