Provider Demographics
NPI:1932984572
Name:CHURCHILL, THERESA ANN (EAMP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:EAMP
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:ANN
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:171 ELIZABETH LN
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-9100
Mailing Address - Country:US
Mailing Address - Phone:425-698-0672
Mailing Address - Fax:
Practice Address - Street 1:171 ELIZABETH LN
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-9100
Practice Address - Country:US
Practice Address - Phone:425-698-0672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61456312171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist