Individual
TAVISHA NAKIA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
9600 VETERANS DRIVE, LAKEWOOD, WA 98493
(253) 582-8440
Mailing address
9916 24TH AVENUE CT S, TACOMA, WA 98444-7743
(253) 217-1763
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
NC60272176
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NC60272176
NAC
WA
Enumeration date
05/01/2014
Last updated
05/01/2014
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