Healthcare Provider Details

I. General information

NPI: 1245406032
Provider Name (Legal Business Name): LAKE TAPPS FAMILY MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 W TAPPS DR E
LAKE TAPPS WA
98391-9176
US

IV. Provider business mailing address

3920 W TAPPS DR E
LAKE TAPPS WA
98391-9176
US

V. Phone/Fax

Practice location:
  • Phone: 253-862-8001
  • Fax: 253-826-4792
Mailing address:
  • Phone: 253-862-8001
  • Fax: 253-826-4792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00009217
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10005138
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10005081
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00036049
License Number StateWA

VIII. Authorized Official

Name: DR. LILA MAUREEN DAY
Title or Position: MD
Credential: MD 00036049 WA
Phone: 253-862-8001