Provider Demographics
NPI:1003508375
Name:EKANGER, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:EKANGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17620 NE 69TH CT UNIT N519
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-7133
Mailing Address - Country:US
Mailing Address - Phone:503-803-0172
Mailing Address - Fax:
Practice Address - Street 1:17620 NE 69TH CT UNIT N519
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7133
Practice Address - Country:US
Practice Address - Phone:503-803-0172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61426206133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered