Healthcare Provider Details

I. General information

NPI: 1922203058
Provider Name (Legal Business Name): TENCY IRENE ERLENBUSCH LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 E 20TH ST STE 3
VANCOUVER WA
98663-3316
US

IV. Provider business mailing address

813 NW 15TH AVE
BATTLE GROUND WA
98604-3237
US

V. Phone/Fax

Practice location:
  • Phone: 360-609-2216
  • Fax:
Mailing address:
  • Phone: 360-609-2216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA00015239
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: