Provider Demographics
NPI:1992928808
Name:ANDERSON, DEBORAH LYNN (LMP)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:WIENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:3806 9TH ST SW
Mailing Address - Street 2:SUITE D
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3687
Mailing Address - Country:US
Mailing Address - Phone:253-770-0412
Mailing Address - Fax:253-770-0511
Practice Address - Street 1:3806 9TH ST SW
Practice Address - Street 2:SUITE D
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3687
Practice Address - Country:US
Practice Address - Phone:253-770-0412
Practice Address - Fax:253-770-0511
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019564225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist