Provider Demographics
NPI:1972822740
Name:TYDE, EMILY JOY (CPM)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:JOY
Last Name:TYDE
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:JOY
Other - Last Name:DOBRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1813 ROCKEFELLER AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2247
Mailing Address - Country:US
Mailing Address - Phone:360-447-8214
Mailing Address - Fax:360-215-3766
Practice Address - Street 1:1200 116TH AVE NE STE C
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3802
Practice Address - Country:US
Practice Address - Phone:425-451-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW61006253175M00000X, 176B00000X
176B00000X, 225700000X, 367A00000X, 374J00000X
OR14913225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No175M00000XOther Service ProvidersMidwife, Lay
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No374J00000XNursing Service Related ProvidersDoula