=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013714658
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JORDAN PYNE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2025
-----------------------------------------------------
Last Update Date | 03/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 721 FAWCETT AVE
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98402-5502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-244-0665
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1016 S 37TH ST UNIT B
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98418-5007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-244-0665
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156F00000X
-----------------------------------------------------
Taxonomy Name | Technician/Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------