Provider Demographics
NPI:1346319712
Name:DUHAMEL, MARK STEPHEN (EAMP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEPHEN
Last Name:DUHAMEL
Suffix:
Gender:M
Credentials:EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 PROSPECT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5399
Mailing Address - Country:US
Mailing Address - Phone:360-621-8310
Mailing Address - Fax:866-313-4004
Practice Address - Street 1:700 PROSPECT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-5399
Practice Address - Country:US
Practice Address - Phone:360-621-8310
Practice Address - Fax:866-313-4004
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002491171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA11618016OtherCAQH