Provider Demographics
NPI:1316163322
Name:MCNAIR, CHARLOTTE L (LMP)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:L
Last Name:MCNAIR
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944
Mailing Address - Country:US
Mailing Address - Phone:509-840-2636
Mailing Address - Fax:
Practice Address - Street 1:1423 E EDISON AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-1667
Practice Address - Country:US
Practice Address - Phone:509-837-6789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015335172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist