Healthcare Provider Details

I. General information

NPI: 1760092704
Provider Name (Legal Business Name): NANCY TURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 45TH AVE NE APT 412
TACOMA WA
98422-4420
US

IV. Provider business mailing address

4602 45TH AVE NE APT 412
TACOMA WA
98422-4420
US

V. Phone/Fax

Practice location:
  • Phone: 253-455-9648
  • Fax:
Mailing address:
  • Phone: 253-455-9648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberMC9601
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: