Healthcare Provider Details

I. General information

NPI: 1013151844
Provider Name (Legal Business Name): MS. TASNEEM T.M. FARUQUI-WILDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13028 1ST AVE S
BURIEN WA
98168-2621
US

IV. Provider business mailing address

602 WHITWORTH LN S
RENTON WA
98057-2413
US

V. Phone/Fax

Practice location:
  • Phone: 206-244-3006
  • Fax:
Mailing address:
  • Phone: 415-271-5259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60069118
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: