Provider Demographics
NPI:1023884053
Name:EIDE, EMILY (MBC-HWC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:EIDE
Suffix:
Gender:F
Credentials:MBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3330
Mailing Address - Country:US
Mailing Address - Phone:989-619-1951
Mailing Address - Fax:
Practice Address - Street 1:407 W PARK ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3330
Practice Address - Country:US
Practice Address - Phone:989-619-1951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIA-3819923171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach