Healthcare Provider Details

I. General information

NPI: 1245662907
Provider Name (Legal Business Name): MONIQUE TIANDRA MCGAFFENY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S 336TH ST STE 100
FEDERAL WAY WA
98003-6745
US

IV. Provider business mailing address

501 S 336TH ST STE 100
FEDERAL WAY WA
98003-6745
US

V. Phone/Fax

Practice location:
  • Phone: 253-235-5314
  • Fax: 253-736-9914
Mailing address:
  • Phone: 253-235-5314
  • Fax: 253-736-9914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60404207
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10003853
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: