Healthcare Provider Details

I. General information

NPI: 1477939106
Provider Name (Legal Business Name): JENNIFER TINTERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER BROTHERTON

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 SOUTH CEDAR ST #300/#200
TACOMA WA
98405
US

IV. Provider business mailing address

P.O. BOX 5299 MS: 1313-5-PCO
TACOMA WA
98415-0299
US

V. Phone/Fax

Practice location:
  • Phone: 253-301-5280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI60727365
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: