Individual
MS. LISA MARIE HEENAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASSAGE PRACTIONER
Contact information
Practice address
4008 W LAKE SAMM PKWY NE APT D1, REDMOND, WA 98052-5627
(425) 463-5476
Mailing address
4008 W LAKE SAMM PKWY NE APT D1, REDMOND, WA 98052-5627
(425) 463-5476
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MA60199222
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA0199222
MASSAGE THERAPIST
WA
Enumeration date
01/24/2011
Last updated
01/24/2011
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