Provider Demographics
NPI:1992470884
Name:VAN TASSEL, MUGGSIE RAY (CERTIFIED PEER)
Entity type:Individual
Prefix:
First Name:MUGGSIE
Middle Name:RAY
Last Name:VAN TASSEL
Suffix:
Gender:M
Credentials:CERTIFIED PEER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 26TH AVE S APT 305
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-4757
Mailing Address - Country:US
Mailing Address - Phone:206-601-7155
Mailing Address - Fax:
Practice Address - Street 1:216 JAMES ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-5102
Practice Address - Country:US
Practice Address - Phone:206-464-6454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist