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General NPI Number Information
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NPI Number | 1003174343
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Entity Type | Individual
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Provider Name | TIFFANY LYNN BATTENFIELD LMP
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Gender | Female
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 04/29/2015
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Provider Practice Location Address
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Address Line | 1806 S LAKE STEVENS RD UNIT A
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City | LAKE STEVENS
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State | WA
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Zip | 98258-7959
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Country | US
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Telephone | 425-319-2376
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Fax |
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Provider Business Mailing Address
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Address Line | 12412 16TH ST NE
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City | LAKE STEVENS
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State | WA
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Zip | 98258-7707
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Country | US
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Telephone | 425-319-2376
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA60258959
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License Number State | WA
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