Healthcare Provider Details

I. General information

NPI: 1831826262
Provider Name (Legal Business Name): COURTNEY NICOLE RASPILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 05/24/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG. 8156 URLASSTRASSE
APO AE
91522
US

IV. Provider business mailing address

3740 SOUTH 14TH ST
TACOMA WA
98433
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-3700
  • Fax:
Mailing address:
  • Phone: 253-967-5271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12767
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: