NPI 1073712170

Tina Marie House, LMP

Practitioner Contractor Vancouver, WA

Practice location

Address: 109 SE 101st Ave, Vancouver, WA 98664-3907
Phone: (360) 256-6748
Mailing address: PO Box 544, Forest Grove, OR 97116-0544

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence MA00023564 (WA)

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Registry record

NPI: 1073712170
Entity type: Individual
Sex (as registered): Female
NPI issued: 17 Jul 2007
Record last updated: 17 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.