Healthcare Provider Details

I. General information

NPI: 1588386486
Provider Name (Legal Business Name): TIFFANY DAWN KENDALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY DAWN STENSTROM

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S PUGET DR APT H223
RENTON WA
98055-4426
US

IV. Provider business mailing address

2100 24TH AVE S STE 260
SEATTLE WA
98144-4644
US

V. Phone/Fax

Practice location:
  • Phone: 407-233-6450
  • Fax:
Mailing address:
  • Phone: 206-382-5340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: