Provider Demographics
NPI:1295108066
Name:TAYYEBI, ANITA (EAMP)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:TAYYEBI
Suffix:
Gender:F
Credentials:EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 NEPEAN DR SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-7733
Mailing Address - Country:US
Mailing Address - Phone:360-485-8749
Mailing Address - Fax:
Practice Address - Street 1:1112 NEPEAN DR SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513-7733
Practice Address - Country:US
Practice Address - Phone:360-485-8749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60608107171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist