Provider Demographics
NPI:1477628766
Name:EIDE, FERNETTE FANG (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNETTE
Middle Name:FANG
Last Name:EIDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FERNETTE
Other - Middle Name:GINLING
Other - Last Name:FANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6701 139TH PL SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-3223
Mailing Address - Country:US
Mailing Address - Phone:425-742-2218
Mailing Address - Fax:
Practice Address - Street 1:6701 139TH PL SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-3223
Practice Address - Country:US
Practice Address - Phone:425-742-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA398162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F38332Medicare UPIN