Provider Demographics
NPI:1962646273
Name:BRINING, TAMARA M (PA)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:M
Last Name:BRINING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W 5TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2715
Mailing Address - Country:US
Mailing Address - Phone:509-344-2663
Mailing Address - Fax:
Practice Address - Street 1:601 W 5TH AVE STE 500
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2756
Practice Address - Country:US
Practice Address - Phone:509-344-8672
Practice Address - Fax:509-747-7838
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60075015363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8542185Medicaid
WAPA60075015OtherLICENSE