Provider Demographics
NPI:1306604491
Name:AETUI, AMYANN T
Entity type:Individual
Prefix:
First Name:AMYANN
Middle Name:T
Last Name:AETUI
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 1:3100 NW BUCKLIN HILL RD
Mailing Address - Street 2:STE 215
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-4367
Mailing Address - Country:US
Mailing Address - Phone:206-602-5074
Mailing Address - Fax:
Practice Address - Street 1:3100 NW BUCKLIN HILL RD
Practice Address - Street 2:STE 215
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-4367
Practice Address - Country:US
Practice Address - Phone:206-602-5074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist