Healthcare Provider Details

I. General information

NPI: 1851628952
Provider Name (Legal Business Name): TINA TSIAKALIS LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EASTLAKE AVE E
SEATTLE WA
98102-3707
US

IV. Provider business mailing address

6219 22ND AVE NE
SEATTLE WA
98115-6917
US

V. Phone/Fax

Practice location:
  • Phone: 206-407-3397
  • Fax: 206-407-3775
Mailing address:
  • Phone: 206-526-8312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW 60095894
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: