Healthcare Provider Details

I. General information

NPI: 1518242239
Provider Name (Legal Business Name): CAITLYN TANG NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

12041 64TH PL S
SEATTLE WA
98178-3600
US

V. Phone/Fax

Practice location:
  • Phone: 206-764-2183
  • Fax:
Mailing address:
  • Phone: 206-225-1206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60250713
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: