Provider Demographics
NPI:1013039437
Name:PANNABECKER, EVA KATHERINE (LAC)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:KATHERINE
Last Name:PANNABECKER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6541 10TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5208
Mailing Address - Country:US
Mailing Address - Phone:206-297-1792
Mailing Address - Fax:
Practice Address - Street 1:2208 NW MARKET ST
Practice Address - Street 2:STE. 408
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4030
Practice Address - Country:US
Practice Address - Phone:206-789-5448
Practice Address - Fax:206-706-4994
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA348171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist