Healthcare Provider Details

I. General information

NPI: 1932574076
Provider Name (Legal Business Name): TAMMY LOUISE GILL B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY LOUISE ASSELIN B.A.

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 W COURT ST
PASCO WA
99301-4153
US

IV. Provider business mailing address

44 S DAWES ST
KENNEWICK WA
99336-2034
US

V. Phone/Fax

Practice location:
  • Phone: 509-545-6506
  • Fax:
Mailing address:
  • Phone: 509-308-5228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: