Healthcare Provider Details

I. General information

NPI: 1790117265
Provider Name (Legal Business Name): AMBER NICOLE CARMEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8351 160TH AVE NE
REDMOND WA
98052-3854
US

IV. Provider business mailing address

17751 NE 90TH ST APT C316
REDMOND WA
98052-6915
US

V. Phone/Fax

Practice location:
  • Phone: 253-218-9327
  • Fax:
Mailing address:
  • Phone: 253-218-9327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60397438
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: