Provider Demographics
NPI:1467778324
Name:SKIFF, DIAMOND KARTIERRA (LMP)
Entity Type:Individual
Prefix:MRS
First Name:DIAMOND
Middle Name:KARTIERRA
Last Name:SKIFF
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:DIAMOND
Other - Middle Name:KARTIERRA
Other - Last Name:REDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:6210 75TH ST W STE A100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8108
Mailing Address - Country:US
Mailing Address - Phone:253-588-1800
Mailing Address - Fax:253-588-8781
Practice Address - Street 1:79 VILLAGE GREEN LOOP
Practice Address - Street 2:APT C
Practice Address - City:STEILACOOM
Practice Address - State:WA
Practice Address - Zip Code:98388-5105
Practice Address - Country:US
Practice Address - Phone:253-777-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60073097174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist