Healthcare Provider Details

I. General information

NPI: 1942218185
Provider Name (Legal Business Name): KATHRYN MCKENZIE TONDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN MEGAN MCKENZIE MD

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 188TH ST S
SPANAWAY WA
98387-4618
US

IV. Provider business mailing address

1019 PACIFIC AVE STE 300 ATTN: HR
TACOMA WA
98402-4488
US

V. Phone/Fax

Practice location:
  • Phone: 253-847-2304
  • Fax: 253-847-8857
Mailing address:
  • Phone: 253-722-1540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00044162
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: