Provider Demographics
NPI:1104055532
Name:VAN AUKEN, TRISH A
Entity type:Individual
Prefix:
First Name:TRISH
Middle Name:A
Last Name:VAN AUKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 EVERGREEN FARM WAY #6065
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-7005
Mailing Address - Country:US
Mailing Address - Phone:360-582-9977
Mailing Address - Fax:
Practice Address - Street 1:660 EVERGREEN FARM WAY
Practice Address - Street 2:#6065
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-7005
Practice Address - Country:US
Practice Address - Phone:360-582-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025051225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist