1598155129 NPI number — TANYA WILKE FAMILY MEDICINE

Table of content: (NPI 1598155129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598155129 NPI number — TANYA WILKE FAMILY MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TANYA WILKE FAMILY MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598155129
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1427 JEFFERSON AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
ENUMCLAW
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98022-3649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-825-2849
Provider Business Mailing Address Fax Number:
360-825-5381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1427 JEFFERSON AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
ENUMCLAW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98022-3649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-825-2849
Provider Business Practice Location Address Fax Number:
360-825-5381
Provider Enumeration Date:
02/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WILKE
Authorized Official First Name:
TANYA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
360-825-2849

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  MD60090609 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0251251 . This is a "STATE L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0274400 . This is a "STATE L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com