=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306653316
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMMY DOANE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2024
-----------------------------------------------------
Last Update Date | 10/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19027 77TH AVE E
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98375-6915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-507-2728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18216 92ND AVE E
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98375-6272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-507-2728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224900000X
-----------------------------------------------------
Taxonomy Name | Mastectomy Fitter
-----------------------------------------------------
License Number | 605-233-660
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------