Individual
ANTOINETTE EVONNE WAYNE
Active
Individual
ANTOINETTE EVONNE WAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMP
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
Update your record
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