Healthcare Provider Details

I. General information

NPI: 1245592575
Provider Name (Legal Business Name): THAVI T THACH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 YAKIMA AVE STE 107
TACOMA WA
98405-5307
US

IV. Provider business mailing address

1708 YAKIMA AVE STE 107
TACOMA WA
98405-5307
US

V. Phone/Fax

Practice location:
  • Phone: 253-272-5881
  • Fax: 253-383-0161
Mailing address:
  • Phone: 253-272-5881
  • Fax: 253-383-0161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60275959
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: