MEDICARE: PROVIDER TRAINING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	00167311	WA

General Provider Information

NPI Number	:	1033550876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDER TRAINING

Provider Business Mailing Address
First Line	:	4212 S 36TH ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98409-2238
Country	:	US
Telephone Number	:	253-272-3376
Fax Number	:

Provider Business Practice Location Address
First Line	:	4212 S 36TH ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98409-2238
Country	:	US
Telephone Number	:	253-272-3376
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL SERVICES
Name	:	MR. MORRIS ELLSWORTH STERLING JR.
Credential	:	REGISTERED NURSE
Telephone Number	:	253-272-3376

Provider Enumeration Date	:	07/09/2013
Last Update Date	:	07/09/2013

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Directions to “PROVIDER TRAINING ” Practice Location

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