Provider Demographics
NPI:1689106072
Name:ESTEVES, ELIANNETTE ENID (MA60615915)
Entity type:Individual
Prefix:
First Name:ELIANNETTE
Middle Name:ENID
Last Name:ESTEVES
Suffix:
Gender:F
Credentials:MA60615915
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6019 ALAMEDA AVE W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98467-2818
Mailing Address - Country:US
Mailing Address - Phone:253-431-4437
Mailing Address - Fax:
Practice Address - Street 1:6019 ALAMEDA AVE W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-2818
Practice Address - Country:US
Practice Address - Phone:253-431-4437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60615915225700000X, 405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention Professional
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAEINOtherMASSAGE