Healthcare Provider Details

I. General information

NPI: 1578318804
Provider Name (Legal Business Name): TASHI LOIS CREFT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 06/01/2024
Certification Date: 06/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 NORTHGATE DR
RICHLAND WA
99352-3505
US

IV. Provider business mailing address

550 GAGE BLVD STE 101
RICHLAND WA
99352-9532
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-2516
  • Fax:
Mailing address:
  • Phone: 509-473-0637
  • Fax: 509-627-2983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberML61544577
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: