Individual
TATYANA V BAKHTINOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
17191 BOTHELL WAY NE, LAKE FOREST PARK, WA 98155-5534
(206) 364-8272
Mailing address
17191 BOTHELL WAY NE, LAKE FOREST PARK, WA 98155-5534
(206) 363-8272
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8473597
—
WA
01
—
GAB25977
MEDICARE GROUP
WA
Enumeration date
07/01/2006
Last updated
11/06/2007
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