Provider Demographics
NPI:1528251279
Name:VANATTA, TAMARA (LMP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:VANATTA
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:PO BOX 11423
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-5423
Mailing Address - Country:US
Mailing Address - Phone:206-842-4168
Mailing Address - Fax:
Practice Address - Street 1:730 ERICKSEN AVE NE
Practice Address - Street 2:SUITE 110
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2837
Practice Address - Country:US
Practice Address - Phone:206-842-4168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014483174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist