Provider Demographics
NPI:1871986695
Name:HEINTZBERGER, INGRID EMILY (EAMP)
Entity type:Individual
Prefix:MS
First Name:INGRID
Middle Name:EMILY
Last Name:HEINTZBERGER
Suffix:
Gender:F
Credentials:EAMP
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:HEINTZBERGER
Other - Last Name:VU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EAMP
Mailing Address - Street 1:350 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3057
Mailing Address - Country:US
Mailing Address - Phone:509-525-0886
Mailing Address - Fax:509-525-9386
Practice Address - Street 1:350 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3057
Practice Address - Country:US
Practice Address - Phone:509-525-0886
Practice Address - Fax:509-525-9386
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 541171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist