Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | WA |
NPI | 1043797012 |
---|---|
Provider Name | Emma Marie Theisen |
First Address | Monroe, WA 98272-2170 |
Second Address | Monroe, WA 98927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2018 |
Last Update Date | 23/07/2018 |