Provider Demographics
NPI:1346562931
Name:NIELSEN, EVA MARIE
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:MARIE
Last Name:NIELSEN
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 1:5304 228TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-3933
Mailing Address - Country:US
Mailing Address - Phone:425-744-2335
Mailing Address - Fax:
Practice Address - Street 1:23303 HWY 99 STE G
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8762
Practice Address - Country:US
Practice Address - Phone:425-697-5188
Practice Address - Fax:425-673-1928
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60021403225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist