Provider Demographics
NPI:1710624622
Name:MEDICINEWATER, RHONDA CHRISTINE
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:CHRISTINE
Last Name:MEDICINEWATER
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 1:211 W HILL ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1460
Mailing Address - Country:US
Mailing Address - Phone:206-504-8669
Mailing Address - Fax:
Practice Address - Street 1:211 W HILL ST STE 3
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1460
Practice Address - Country:US
Practice Address - Phone:206-504-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAACUP.AC.61256312171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty