Individual
LACIE WANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5331 WHIPPORWILL DR., HOLIDAY, FL 34690
(218) 244-2405
Mailing address
5331 WHIPPOORWILL DR, HOLIDAY, FL 34690-2144
(218) 244-2405
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
83387
FL
Other
Enumeration date
12/21/2016
Last updated
12/21/2016
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