MEDICARE: MRS. TAMARA STONE VANOVER MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1972258861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMARA STONE VANOVER MS

Provider Business Mailing Address
First Line	:	223 E 4TH ST STE 12
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-3000
Country	:	US
Telephone Number	:	360-565-2602
Fax Number	:	360-417-2410

Provider Business Practice Location Address
First Line	:	223 E 4TH ST STE 12
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-3000
Country	:	US
Telephone Number	:	360-565-2602
Fax Number	:	360-417-2410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2022
Last Update Date	:	02/18/2022

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