Healthcare Provider Details

I. General information

NPI: 1174443956
Provider Name (Legal Business Name): EMMA JENNINGS, DIANE AUFLICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 MARTIN ST
BLAINE WA
98230-4045
US

IV. Provider business mailing address

10727 BURKE AVE N
SEATTLE WA
98133-8966
US

V. Phone/Fax

Practice location:
  • Phone: 360-788-4228
  • Fax:
Mailing address:
  • Phone: 206-209-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: