Provider Demographics
NPI:1497977516
Name:EMENKE, UNKNOWN (ND, LMP MMP EFT-CC)
Entity Type:Individual
Prefix:MS
First Name:UNKNOWN
Middle Name:
Last Name:EMENKE
Suffix:
Gender:F
Credentials:ND, LMP MMP EFT-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16222 14TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-6346
Mailing Address - Country:US
Mailing Address - Phone:206-362-4707
Mailing Address - Fax:
Practice Address - Street 1:16222 14TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-6346
Practice Address - Country:US
Practice Address - Phone:206-362-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012692225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0199997OtherLABOR AND INDUSTRIES