Provider Demographics
NPI:1184745796
Name:EIDE NEUROLEARNING CLINIC, INC P.S.
Entity type:Organization
Organization Name:EIDE NEUROLEARNING CLINIC, INC P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FERNETTE
Authorized Official - Middle Name:FANG
Authorized Official - Last Name:EIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-742-2218
Mailing Address - Street 1:6701 139TH PL SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-3223
Mailing Address - Country:US
Mailing Address - Phone:425-742-2218
Mailing Address - Fax:425-609-0050
Practice Address - Street 1:6701 139TH PL SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-3223
Practice Address - Country:US
Practice Address - Phone:425-742-2218
Practice Address - Fax:425-609-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA39835207R00000X
WA398162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty