Healthcare Provider Details

I. General information

NPI: 1245849249
Provider Name (Legal Business Name): TRESA DEE MCCORMICK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRESA DEE SIMPSON

II. Dates (important events)

Enumeration Date: 07/26/2020
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34709 9TH AVE S STE B500
FEDERAL WAY WA
98003-6789
US

IV. Provider business mailing address

34709 9TH AVE S STE B500
FEDERAL WAY WA
98003-6789
US

V. Phone/Fax

Practice location:
  • Phone: 253-944-6950
  • Fax: 253-661-8603
Mailing address:
  • Phone: 253-944-6950
  • Fax: 253-661-8603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP61035964
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: