Healthcare Provider Details

I. General information

NPI: 1578801486
Provider Name (Legal Business Name): MRS. PATRICIA M TIBBITTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA M JOWERS R.N.

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12801 86TH AVE E
PUYALLUP WA
98373-5454
US

IV. Provider business mailing address

1000 CRESO RD
SPANAWAY WA
98387-8990
US

V. Phone/Fax

Practice location:
  • Phone: 253-840-8968
  • Fax: 253-840-8802
Mailing address:
  • Phone: 253-539-7022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00083399
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: