Provider Demographics
NPI:1336685031
Name:CHRISTENSEN, EMMA JANE
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:JANE
Last Name:CHRISTENSEN
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 1:9603 13TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-2353
Mailing Address - Country:US
Mailing Address - Phone:503-506-8601
Mailing Address - Fax:
Practice Address - Street 1:1417 NW 54TH ST
Practice Address - Street 2:SUITE 464
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3570
Practice Address - Country:US
Practice Address - Phone:503-506-8601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60468448173C00000X, 225700000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist
No374J00000XNursing Service Related ProvidersDoula