Active NPI
Ivy Atisa Nanigans, LMT
- Massage Therapist
- Vancouver, WA
National Provider Identifier
1417708447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 61511736
- Practice address
- 1508 Broadway St
Vancouver, WA 98663-3434 - Phone
- (360) 635-3477
- NPI assigned
- Mar 28, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 61511736 | WA | Primary |
Addresses
Primary practice location
1508 Broadway St
Vancouver, WA 98663-3434
Mailing address
303 N Garrison Rd
Vancouver, WA 98664-1415
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61511736 | WA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| At Vancouver Massage, LLC | Massage Therapist | Current | Accepting new patients |
Locations
1508 Broadway St
Vancouver, WA 98663
Phone (360) 635-3477
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711584000000",
"number": "1417708447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "303 N GARRISON RD",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986641415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1508 BROADWAY ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986633434",
"telephone_number": "360-635-3477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NANIGANS",
"first_name": "IVY",
"middle_name": "ATISA",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-03-28",
"last_updated": "2024-03-28",
"certification_date": "2024-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "61511736",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.