Healthcare Provider Details

I. General information

NPI: 1184745796
Provider Name (Legal Business Name): EIDE NEUROLEARNING CLINIC, INC P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 139TH PL SW
EDMONDS WA
98026-3223
US

IV. Provider business mailing address

6701 139TH PL SW
EDMONDS WA
98026-3223
US

V. Phone/Fax

Practice location:
  • Phone: 425-742-2218
  • Fax: 425-609-0050
Mailing address:
  • Phone: 425-742-2218
  • Fax: 425-609-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39835
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number39816
License Number StateWA

VIII. Authorized Official

Name: FERNETTE FANG EIDE
Title or Position: CO-PRESIDENT
Credential: M.D.
Phone: 425-742-2218