Provider Demographics
NPI:1962824755
Name:THARP, ENGRACIA (EAMP, LAC)
Entity Type:Individual
Prefix:
First Name:ENGRACIA
Middle Name:
Last Name:THARP
Suffix:
Gender:F
Credentials:EAMP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3057
Mailing Address - Street 2:SUITE I
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-0137
Mailing Address - Country:US
Mailing Address - Phone:425-835-2503
Mailing Address - Fax:425-285-5436
Practice Address - Street 1:450 NW GILMAN BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2483
Practice Address - Country:US
Practice Address - Phone:425-835-2503
Practice Address - Fax:425-285-5436
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60434405171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist