1801317284 NPI number — TIFFANIE MARIE MEEKS SWENSON ARNP

Table of content: TIFFANIE MARIE MEEKS SWENSON ARNP (NPI 1801317284)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801317284 NPI number — TIFFANIE MARIE MEEKS SWENSON ARNP

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
SWENSON

Provider First Name:
TIFFANIE

Provider Middle Name:
MARIE MEEKS

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:
ARNP

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801317284

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
12/28/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5299

Provider Second Line Business Mailing Address:
MS: 820-5-PCO

Provider Business Mailing Address City Name:
TACOMA

Provider Business Mailing Address State Name:
WA

Provider Business Mailing Address Postal Code:
98415-0299

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3124 S 19TH ST STE C140

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
TACOMA

Provider Business Practice Location Address State Name:
WA

Provider Business Practice Location Address Postal Code:
98405-2479

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
253-792-6680

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
07/06/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 163WC0200X , with the licence number: RN60096331 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 363LF0000X , with the licence number: AP60807005 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .