1891348751 NPI number — MRS. LUCIE LE NGUYEN I MA60973652

Table of content: MRS. LUCIE LE NGUYEN I MA60973652 (NPI 1891348751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891348751 NPI number — MRS. LUCIE LE NGUYEN I MA60973652

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LE NGUYEN
Provider First Name:
LUCIE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
I
Provider Credential Text:
MA60973652
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891348751
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3102 SE 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98056-5818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-524-5569
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
680 NW GILMAN BLVD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISSAQUAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98027-2454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-427-6562
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA60973652 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MA60973652 . This is a "LICENSED MASSAGE THERAPIST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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