Provider Demographics
NPI:1760774285
Name:DY, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DY
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 1:3925 159TH AVE NE BLDG 21
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3925 159TH AVENUE NE
Practice Address - Street 2:BLD 21
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121
Practice Address - Country:US
Practice Address - Phone:425-215-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT014382207Q00000X
WA60605790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063770196OtherLIVING WELL HEALTH CENTER