Healthcare Provider Details

I. General information

NPI: 1861154577
Provider Name (Legal Business Name): DAVID P TWIETMEYER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2021
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 S UNION AVE STE 120
TACOMA WA
98405-1322
US

IV. Provider business mailing address

5414 DISCOVERY ST E
FIFE WA
98424-3802
US

V. Phone/Fax

Practice location:
  • Phone: 253-563-0198
  • Fax:
Mailing address:
  • Phone: 253-466-8183
  • Fax: 206-212-8447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61396149
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberRN60371368
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: