Provider Demographics
NPI:1063715084
Name:GRICE, TANISHA RENEE (IBCLC, NAC)
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:RENEE
Last Name:GRICE
Suffix:
Gender:F
Credentials:IBCLC, NAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16430 EUCLID AVE NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1148
Mailing Address - Country:US
Mailing Address - Phone:206-432-5460
Mailing Address - Fax:
Practice Address - Street 1:16430 EUCLID AVE NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1148
Practice Address - Country:US
Practice Address - Phone:206-432-5460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA11099970174N00000X
374J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula
No376K00000XNursing Service Related ProvidersNurse's Aide