Healthcare Provider Details

I. General information

NPI: 1336395896
Provider Name (Legal Business Name): MIHEE MICKEY MONTSTREAM ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S J ST
TACOMA WA
98405-4933
US

IV. Provider business mailing address

1717 S J ST
TACOMA WA
98405-4933
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-6691
  • Fax: 253-426-6492
Mailing address:
  • Phone: 253-426-6691
  • Fax: 253-426-6492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60039532
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00127876
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: