Provider Demographics
NPI:1144898636
Name:PHILLIPS, TAMMI LYN (RN60521239)
Entity type:Individual
Prefix:
First Name:TAMMI
Middle Name:LYN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN60521239
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20807 229TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-8919
Mailing Address - Country:US
Mailing Address - Phone:206-856-8628
Mailing Address - Fax:
Practice Address - Street 1:3518 6TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-5419
Practice Address - Country:US
Practice Address - Phone:800-628-7649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60521239163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse