Healthcare Provider Details

I. General information

NPI: 1194520650
Provider Name (Legal Business Name): EILEEN RUBY DEMING PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 YAKIMA AVE STE 105
TACOMA WA
98405-5300
US

IV. Provider business mailing address

1708 YAKIMA AVE STE 105
TACOMA WA
98405-5300
US

V. Phone/Fax

Practice location:
  • Phone: 253-552-1200
  • Fax: 253-552-1239
Mailing address:
  • Phone: 253-552-1200
  • Fax: 253-552-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA70044160
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA70044160
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: