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General NPI Number Information
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NPI Number | 1962137125
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Entity Type | Organization
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Legal Business Name | EATONVILLE INTEGRATIVE MEDICINE P.S.
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Dates
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Enumeration Date | 07/21/2022
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 320 CENTER STREET EAST
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City | EATONVILLE
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State | WA
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Zip | 98328-7449
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Country | US
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Telephone | 360-832-2222
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Fax | 360-859-9592
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Provider Business Mailing Address
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Address Line | PO BOX 1924
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City | EATONVILLE
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State | WA
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Zip | 98328-1924
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Country | US
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Telephone | 360-832-2222
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Fax | 360-859-9592
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Authorized Official
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Title or Position | PRESIDENT
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Name | MELISSA BRONOSKE
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Credential | PA-C
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Telephone | 253-677-4894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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