Healthcare Provider Details

I. General information

NPI: 1073188611
Provider Name (Legal Business Name): TIARA TANEE CARR CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 5TH ST SE STE 3200
PUYALLUP WA
98372-4689
US

IV. Provider business mailing address

PO BOX 5299 MS: 820-5-PCO
TACOMA WA
98415-0299
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-3550
  • Fax: 253-697-3490
Mailing address:
  • Phone:
  • Fax: 253-274-7991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN60968923
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP61338414
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: