Individual
MR. KORDALE TRE BAVOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
10004 204TH AVE E STE 1300, BONNEY LAKE, WA 98391-6537
(253) 848-8797
Mailing address
10004 204TH AVE E STE 1300, BONNEY LAKE, WA 98391-6537
(253) 848-8797
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
61422757
WA
Other
Enumeration date
08/28/2020
Last updated
08/22/2023
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