Provider Demographics
NPI:1992185359
Name:POMEROY, EMILY ANN (LMP)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ANN
Last Name:POMEROY
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 1:5422 212TH ST SW APT G101
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2076
Mailing Address - Country:US
Mailing Address - Phone:360-520-0199
Mailing Address - Fax:
Practice Address - Street 1:3302 FUHRMAN AVE E STE 110
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-7115
Practice Address - Country:US
Practice Address - Phone:206-402-4012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60561356390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program