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Individual
NIKKI LEE DVORAK
Active
Individual
NIKKI LEE DVORAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA00020416
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0143536
L & I
WA
01
—
6978-DV-COLBY AVE
REGENCE
WA
Enumeration date
04/04/2006
Last updated
11/26/2008
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