Individual
STACEY JONELLE VAN TASSEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.P.
Contact information
Practice address
29034 216TH AVE SE, BLACK DIAMOND, WA 98010-1297
(360) 886-2649
Mailing address
26615 199TH PL SE, COVINGTON, WA 98042-5087
(253) 670-5910
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00020492
WA
Other
Enumeration date
09/21/2007
Last updated
09/21/2007
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