Provider Demographics
NPI:1740788892
Name:EDEN, MARTHA (EAMP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:EDEN
Suffix:
Gender:F
Credentials:EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 PERCIVAL ST NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4933
Mailing Address - Country:US
Mailing Address - Phone:360-529-7420
Mailing Address - Fax:
Practice Address - Street 1:203 4TH AVE E STE 505
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1190
Practice Address - Country:US
Practice Address - Phone:360-529-7420
Practice Address - Fax:360-529-7420
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60240253171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist