Provider Demographics
NPI:1760205967
Name:MIER, CENISA (MA61626227)
Entity type:Individual
Prefix:
First Name:CENISA
Middle Name:
Last Name:MIER
Suffix:
Gender:F
Credentials:MA61626227
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2834A MONFORE DR # A
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE LEWIS MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98433-1048
Mailing Address - Country:US
Mailing Address - Phone:832-318-9227
Mailing Address - Fax:
Practice Address - Street 1:655 GOLF CLUB PL SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1088
Practice Address - Country:US
Practice Address - Phone:360-352-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61626227225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist