Provider Demographics
NPI:1497158992
Name:BARCK, TAWNA L (PA)
Entity Type:Individual
Prefix:
First Name:TAWNA
Middle Name:L
Last Name:BARCK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:8904 NE 15TH AVE C25
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665
Mailing Address - Country:US
Mailing Address - Phone:907-947-2866
Mailing Address - Fax:
Practice Address - Street 1:310 S ROOSEVELT
Practice Address - Street 2:
Practice Address - City:GOLDENDALE
Practice Address - State:WA
Practice Address - Zip Code:98620
Practice Address - Country:US
Practice Address - Phone:509-773-4022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical