Healthcare Provider Details

I. General information

NPI: 1568255685
Provider Name (Legal Business Name): EMILY A REPPE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6019 NOBLE CT
WEST RICHLAND WA
99353-7959
US

IV. Provider business mailing address

6019 NOBLE CT
WEST RICHLAND WA
99353-7959
US

V. Phone/Fax

Practice location:
  • Phone: 509-378-0594
  • Fax:
Mailing address:
  • Phone: 509-378-0594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH60986226
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: