Provider Demographics
NPI:1316194814
Name:HANSON, TOBIE J (LMP)
Entity Type:Individual
Prefix:
First Name:TOBIE
Middle Name:J
Last Name:HANSON
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 1:23220 MAPLE VALLEY BLACK DIAMOND RD SE STE 13
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-8249
Mailing Address - Country:US
Mailing Address - Phone:425-432-1449
Mailing Address - Fax:
Practice Address - Street 1:23220 MAPLE VALLEY BLACK DIAMOND RD SE STE 13
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8249
Practice Address - Country:US
Practice Address - Phone:425-432-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013825174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0205964OtherLABOR & INDUSTRIES
WA1316194814OtherSURNAME CHANGE DUE TO MARRIAGE