MEDICARE: MOLLY J TINSLEY LMP

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	174400000X	Specialist	MA00021131	WA

General Provider Information

NPI Number	:	1730229428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY J TINSLEY LMP

Provider Business Mailing Address
First Line	:	1602 ADAMS ST
Second Line	:
City	:	STEILACOOM
State	:	WA
Zip	:	98388-3806
Country	:	US
Telephone Number	:	253-820-6918
Fax Number	:

Provider Business Practice Location Address
First Line	:	10100 BRIDGEPORT WAY SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-2302
Country	:	US
Telephone Number	:	253-820-6918
Fax Number	:	253-983-9474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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