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General NPI Number Information
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NPI Number | 1902328024
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Entity Type | Individual
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Provider Name | MARA LOUISE EIDSVOOG HIS
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Gender | Female
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 12/13/2018
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Provider Practice Location Address
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Address Line | 21701 76TH AVE W STE 306
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City | EDMONDS
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State | WA
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Zip | 98026-7536
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Country | US
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Telephone | 425-582-8264
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Fax | 253-759-2988
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Provider Business Mailing Address
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Address Line | 1311 S UNION AVE STE 102
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City | TACOMA
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State | WA
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Zip | 98405-1959
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Country | US
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Telephone | 253-759-3555
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Fax | 253-759-2988
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HA60740882
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License Number State | WA
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