Provider Demographics
NPI:1013231851
Name:EMRIE, THERESA M (LAC, MACOM)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:EMRIE
Suffix:
Gender:F
Credentials:LAC, MACOM
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 1603
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85636-1603
Mailing Address - Country:US
Mailing Address - Phone:520-236-3975
Mailing Address - Fax:520-458-2045
Practice Address - Street 1:471 BARTOW DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-1838
Practice Address - Country:US
Practice Address - Phone:520-236-3975
Practice Address - Fax:520-458-2045
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0677171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist