Individual
TATYANA TIMOFEYEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
605 S COOLIDGE ST, MOSES LAKE, WA 98837
(509) 765-0674
Mailing address
605 S COOLIDGE ST, MOSES LAKE, WA 98837-1893
(509) 765-0674
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
PA61003681
WA
Other
Enumeration date
09/10/2018
Last updated
09/10/2019
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