Individual
MELANIE TISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
340 WHITE RIVER PARK RD, BUCKLEY, WA 98321
(360) 829-5919
Mailing address
12003 258TH AVE CT E, BUCKLEY, WA 98321
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP00054717
WA
Other
Enumeration date
10/24/2019
Last updated
10/24/2019
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