Organization
INTEGRATED FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACI MICHELLE MANCUSO ARNP (FAMILY NURSE PRACTITIONER)
(509) 389-6945
Entity
Organization
Contact information
Practice address
4901 108TH ST SW, LAKEWOOD, WA 98499-3724
(253) 589-6573
(253) 984-1079
Mailing address
PO BOX 98886, LAKEWOOD, WA 98496-8886
(509) 389-6945
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP30006855
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649402942
—
WA
Enumeration date
08/20/2009
Last updated
09/27/2011
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