Individual
DIEDRA DULANEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
1436 NW BENTON ST, CAMAS, WA 98607-1542
(360) 904-5145
Mailing address
1436 NW BENTON ST, CAMAS, WA 98607-1542
(360) 904-5145
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA60492981
WA
Other
Enumeration date
08/19/2014
Last updated
09/24/2014
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