Healthcare Provider Details

I. General information

NPI: 1356522593
Provider Name (Legal Business Name): NADYA TAHRI LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 S MILITARY RD
WINLOCK WA
98596-9312
US

IV. Provider business mailing address

819 S MILITARY RD
WINLOCK WA
98596-9312
US

V. Phone/Fax

Practice location:
  • Phone: 503-944-9805
  • Fax:
Mailing address:
  • Phone: 503-944-9805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number00020944
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: