Provider Demographics
NPI:1538249446
Name:SIFRE, JAIME ANTONIO (RN)
Entity type:Individual
Prefix:MR
First Name:JAIME
Middle Name:ANTONIO
Last Name:SIFRE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:9109 73RD STREET CT SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-3995
Mailing Address - Country:US
Mailing Address - Phone:253-583-1159
Mailing Address - Fax:253-583-1402
Practice Address - Street 1:PRIMARY AND SPECIALTY MEDICAL CARE
Practice Address - Street 2:9600 VETERANS DRIVE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-0001
Practice Address - Country:US
Practice Address - Phone:253-583-1159
Practice Address - Fax:253-583-1402
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WARN00143743163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice