Individual
MITZI GAYLE LAWSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
1790 SIDNEY AVE, # 8-331, PORT ORCHARD, WA 98366-2439
(360) 649-8419
Mailing address
1790 SIDNEY AVE, # 8-331, PORT ORCHARD, WA 98366-2439
(360) 649-8419
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00007462
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA00007462
LICENSED MASSAGE PRACTITIONER
WA
Enumeration date
11/20/2009
Last updated
11/20/2009
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