Healthcare Provider Details

I. General information

NPI: 1104251792
Provider Name (Legal Business Name): TERESA KATHLEEN SCHREIBER MHS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 5TH ST SE STE 4200
PUYALLUP WA
98372-4604
US

IV. Provider business mailing address

315 MARTIN LUTHER KING JR WAY M/S 737-3-PCON,737 FAWCETT
TACOMA WA
98405-4234
US

V. Phone/Fax

Practice location:
  • Phone: 253-792-6555
  • Fax:
Mailing address:
  • Phone: 253-459-8231
  • Fax: 253-459-7863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number60696522
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: