Healthcare Provider Details

I. General information

NPI: 1144792540
Provider Name (Legal Business Name): DORA ANN DUKE HM60711152
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2018
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 S FIFE ST STE 301
TACOMA WA
98409-7309
US

IV. Provider business mailing address

10514 363RD STREET CT E
EATONVILLE WA
98328-9318
US

V. Phone/Fax

Practice location:
  • Phone: 253-589-5334
  • Fax:
Mailing address:
  • Phone: 253-722-4151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60810528
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: