Provider Demographics
NPI:1932316650
Name:SALAMONIK, EVA B (LMP)
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:B
Last Name:SALAMONIK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15617 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-3623
Mailing Address - Country:US
Mailing Address - Phone:206-778-6632
Mailing Address - Fax:
Practice Address - Street 1:15617 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-3623
Practice Address - Country:US
Practice Address - Phone:206-778-6632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020695174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00020695OtherMASSAGE LICENCE NUMBER