Provider Demographics
NPI:1609328970
Name:MOW, ARIELLE FARIDHA (LAC, EAMP)
Entity Type:Individual
Prefix:
First Name:ARIELLE
Middle Name:FARIDHA
Last Name:MOW
Suffix:
Gender:F
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 STRONGHOLD LN
Mailing Address - Street 2:
Mailing Address - City:LOPEZ ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98261-8067
Mailing Address - Country:US
Mailing Address - Phone:360-468-3852
Mailing Address - Fax:
Practice Address - Street 1:210 LOPEZ RD
Practice Address - Street 2:
Practice Address - City:LOPEZ ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98261-8851
Practice Address - Country:US
Practice Address - Phone:360-468-3239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60537226171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist