Provider Demographics
NPI:1912455619
Name:TRENTHAM, EMILIA
Entity Type:Individual
Prefix:
First Name:EMILIA
Middle Name:
Last Name:TRENTHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19301 RICHMOND BEACH DR NW
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2956
Mailing Address - Country:US
Mailing Address - Phone:281-799-0513
Mailing Address - Fax:
Practice Address - Street 1:1525 4TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1607
Practice Address - Country:US
Practice Address - Phone:206-624-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60664653174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist