Individual
THAI LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
2302 S UNION AVE STE 30, TACOMA, WA 98405-1361
(253) 365-8074
Mailing address
2302 S UNION AVE STE 30, TACOMA, WA 98405-1361
(253) 365-8074
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP61225098
WA
Other
Enumeration date
10/06/2021
Last updated
08/04/2023
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