Individual
ANTOINETTE EVONNE WAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
1804 W UNION AVE STE 101, TACOMA, WA 98405
(951) 696-9353
(951) 973-7216
Mailing address
24630 WASHINGTON AVE STE 200, MURRIETA, CA 92562-6177
(951) 696-9353
(951) 973-7216
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699269175
NPI
WA
01
—
MA60848027
MMT LICENSURE
WA
Enumeration date
06/19/2018
Last updated
06/25/2018
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