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Individual

MIHEE MICKEY MONTSTREAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ARNP

Contact information

Practice address
1717 S J ST, TACOMA, WA 98405-4933
(253) 426-6691
(253) 426-6492
Mailing address
1717 S J ST, TACOMA, WA 98405-4933
(253) 426-6691
(253) 426-6492

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN00127876
WA
363L00000X
Nurse Practitioner
Primary
AP60039532
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0238994
STATE L&I
WA
01
0278223
STATE L&I
WA
01
0278232
STATE L&I
WA
01
0279447
STATE L&I
WA
01
0279449
STATE L&I
WA
01
0287255
STATE L&I
WA
01
0287481
STATE L&I
WA
01
0291785
STATE L&I
WA
01
8948258
CRIME VICTIMS
WA
05
9658444
WA
Enumeration date
08/14/2008
Last updated
05/03/2012
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