Provider Demographics
NPI:1316192057
Name:SCRIVEN, TANNA A (LMP)
Entity Type:Individual
Prefix:
First Name:TANNA
Middle Name:A
Last Name:SCRIVEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4822 S M ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-3505
Mailing Address - Country:US
Mailing Address - Phone:253-202-6626
Mailing Address - Fax:
Practice Address - Street 1:4822 S M ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-3505
Practice Address - Country:US
Practice Address - Phone:253-202-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012052171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00012052OtherWASHINGTON STATE DEPT OF HEALTH