Individual
MISS TRACIE MARIE JEFFERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11216 SUNRISE BLVD E STE 3-106, PUYALLUP, WA 98374-8848
(253) 848-5951
(253) 845-7073
Mailing address
3908 10TH ST SE, PUYALLUP, WA 98374-2188
(253) 848-5951
(253) 845-7073
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60596875
WA
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2048296
—
WA
Enumeration date
09/16/2014
Last updated
08/24/2017
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