Individual
MR. NATHAN CHARLES DAGGETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1903 ALABAMA ST, LONGVIEW, WA 98632-1414
(503) 477-0460
Mailing address
1903 ALABAMA ST, LONGVIEW, WA 98632-1414
(503) 477-0460
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
18487
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18487
MASSAGE LICENSE
OR
Enumeration date
07/19/2012
Last updated
07/19/2012
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