Healthcare Provider Details

I. General information

NPI: 1679107239
Provider Name (Legal Business Name): TAMARA EKLUND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2020
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11102 SUNRISE BLVD E STE 104
PUYALLUP WA
98374-8846
US

IV. Provider business mailing address

413 LILLY RD NE
OLYMPIA WA
98506-5133
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-8797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP61300688
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00149342
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: