Individual
MRS. BRENDA D PAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
205 BETHEL AVE, PORT ORCHARD, WA 98366-5215
(360) 440-2590
(360) 874-1739
Mailing address
2326 GOLDFINCH ST, APT C, OAK HARBOR, WA 98277-4783
(360) 720-2595
(360) 874-1739
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00018640
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4146S5-00
FULL CIRCLE ID
WA
01
—
MA00018640
MASSAGE LICENSE #
WA
Enumeration date
03/13/2007
Last updated
07/08/2007
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