Provider Demographics
NPI:1487014809
Name:EMRY, MADISON CLAIR (LMP)
Entity Type:Individual
Prefix:MS
First Name:MADISON
Middle Name:CLAIR
Last Name:EMRY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11002 62ND AVE E
Mailing Address - Street 2:8-303
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-5834
Mailing Address - Country:US
Mailing Address - Phone:253-324-6419
Mailing Address - Fax:
Practice Address - Street 1:4017 A STREET SE
Practice Address - Street 2:B101
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002
Practice Address - Country:US
Practice Address - Phone:253-939-8144
Practice Address - Fax:253-939-2289
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60503660174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist