Provider Demographics
NPI:1104979749
Name:SILVA, TRACIE A (LMP)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:A
Last Name:SILVA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8717 194TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-4202
Mailing Address - Country:US
Mailing Address - Phone:253-224-3285
Mailing Address - Fax:
Practice Address - Street 1:10324 CANYON RD E
Practice Address - Street 2:STE 105
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1013
Practice Address - Country:US
Practice Address - Phone:253-537-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011708174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist