Provider Demographics
NPI:1699898015
Name:BARTLETT, TINA L (LMP)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:L
Last Name:BARTLETT
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 1:507 DEVOE ST SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2016
Mailing Address - Country:US
Mailing Address - Phone:360-943-2200
Mailing Address - Fax:206-339-6180
Practice Address - Street 1:507 DEVOE ST SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2016
Practice Address - Country:US
Practice Address - Phone:360-943-2200
Practice Address - Fax:206-339-6180
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013561171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor