Individual
MS. TINA MARIE HOUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.P
Contact information
Practice address
109 SE 101ST AVE, VANCOUVER, WA 98664-3907
(360) 256-6748
Mailing address
PO BOX 544, FOREST GROVE, OR 97116-0544
(360) 773-3347
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MA00023564
WA
Other
Enumeration date
07/17/2007
Last updated
07/17/2007
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