Provider Demographics
NPI:1982997912
Name:FONTES, EMILY CHARLOTTE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:CHARLOTTE
Last Name:FONTES
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13729 CASCADIAN WAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7345
Mailing Address - Country:US
Mailing Address - Phone:425-750-4759
Mailing Address - Fax:
Practice Address - Street 1:16825 48TH AVE W
Practice Address - Street 2:SUITE 434
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-6401
Practice Address - Country:US
Practice Address - Phone:425-522-2294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60168141225700000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula