Provider Demographics
NPI:1992528137
Name:BURKE, TIFFENY (MA-P #PC61296748)
Entity type:Individual
Prefix:
First Name:TIFFENY
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:MA-P #PC61296748
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 SW 331ST ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2833
Mailing Address - Country:US
Mailing Address - Phone:253-431-3273
Mailing Address - Fax:
Practice Address - Street 1:522 W RIVERSIDE AVE STE N
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0581
Practice Address - Country:US
Practice Address - Phone:253-216-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPC61495222246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy