Provider Demographics
NPI:1932393279
Name:OUELLETTE, YVONNE ROSE (LMP)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:ROSE
Last Name:OUELLETTE
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 1:3935 PACIFIC WAY
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-5332
Mailing Address - Country:US
Mailing Address - Phone:360-423-2818
Mailing Address - Fax:360-425-0684
Practice Address - Street 1:3935 PACIFIC WAY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-5332
Practice Address - Country:US
Practice Address - Phone:360-423-2818
Practice Address - Fax:360-425-0684
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015387225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist