Individual
MRS. AUTUMN VIVIENNE FALK-O'DENIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC LMP
Contact information
Practice address
9123 271ST NW, S, STANWOOD, WA 98292
(425) 530-0594
(360) 659-3918
Mailing address
P.O. BOX 181, STANWOOD, WA 98292
(425) 530-0594
(360) 659-3918
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC61413207
WA
225700000X
Massage Therapist
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108835
L & I
WA
01
—
364802001
PREMERA
WA
Enumeration date
04/04/2007
Last updated
05/06/2024
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