Basic Information
| Provider Information | |||||||||
| NPI: | 1275925307 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUMMEL | ||||||||
| FirstName: | VERDI | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1911 | ||||||||
| Address2: | |||||||||
| City: | SISTERS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977591911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415493534 | ||||||||
| FaxNumber: | 5415491272 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 N LOCUST ST | ||||||||
| Address2: | |||||||||
| City: | SISTERS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977595047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415493534 | ||||||||
| FaxNumber: | 5415491272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2015 | ||||||||
| LastUpdateDate: | 02/26/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 12764 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.