Healthcare Provider Details

I. General information

NPI: 1316181472
Provider Name (Legal Business Name): THREE TREE INFUSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3819 100TH ST SW SUITE 7-C
LAKEWOOD WA
98499-4470
US

IV. Provider business mailing address

16259 SYLVESTER RD SW SUITE 404
BURIEN WA
98166-3049
US

V. Phone/Fax

Practice location:
  • Phone: 253-588-7911
  • Fax: 253-984-6774
Mailing address:
  • Phone: 206-243-3049
  • Fax: 206-244-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRIS L PORTER
Title or Position: PROVIDER/ OWNER
Credential: ARNP
Phone: 206-244-4704