Provider Demographics
NPI:1386880003
Name:HUGHES, JUSTIN PAUL (LMP)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:PAUL
Last Name:HUGHES
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2099 NE VICTORIAN LN
Mailing Address - Street 2:D
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2326
Mailing Address - Country:US
Mailing Address - Phone:206-920-3996
Mailing Address - Fax:
Practice Address - Street 1:164 KNECHTEL WAY NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2838
Practice Address - Country:US
Practice Address - Phone:206-920-3996
Practice Address - Fax:206-920-3996
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007951163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)