Provider Demographics
NPI:1275157695
Name:TRYON, MICAH D'YARAH (LM)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:D'YARAH
Last Name:TRYON
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SYCAMORE DR SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-4822
Mailing Address - Country:US
Mailing Address - Phone:253-961-3366
Mailing Address - Fax:
Practice Address - Street 1:1201 SYCAMORE DR SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-4822
Practice Address - Country:US
Practice Address - Phone:253-961-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW61061055176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife