Individual
MS. MARA LOUISE EIDSVOOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HIS
Contact information
Practice address
21701 76TH AVE W STE 306, EDMONDS, WA 98026-7536
(425) 582-8264
(253) 759-2988
Mailing address
1311 S UNION AVE STE 102, TACOMA, WA 98405-1959
(253) 759-3555
(253) 759-2988
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
HA60740882
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1091043
—
WA
Enumeration date
07/11/2017
Last updated
12/13/2018
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