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Individual
MRS. LYRLENE KQM JAVELLANA
Active
Individual
MRS. LYRLENE KQM JAVELLANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMP
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA00017760
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0192232
L&I PROVIDER NUMBER
WA
01
—
91792822
EMPLOYER ID NUMBER
WA
01
—
MA00017760
STATE LICENSE - MASSAGE
WA
Enumeration date
03/15/2007
Last updated
07/08/2007
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