Provider Demographics
NPI:1285367698
Name:TAMBORERO- FERNANDEZ, MONICA N/A (RN)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:N/A
Last Name:TAMBORERO- FERNANDEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14905 16TH PL W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-5043
Mailing Address - Country:US
Mailing Address - Phone:617-901-9463
Mailing Address - Fax:
Practice Address - Street 1:14905 16TH PL W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-5043
Practice Address - Country:US
Practice Address - Phone:617-901-9463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6077657163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology