Provider Demographics
NPI:1508192915
Name:URDAHL, TAUNI M (PA-C)
Entity Type:Individual
Prefix:
First Name:TAUNI
Middle Name:M
Last Name:URDAHL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAUNI
Other - Middle Name:MARIE
Other - Last Name:LISENBEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3900 S ZINTEL WAY
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-5092
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:1100 GOETHALS DRIVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3304
Practice Address - Country:US
Practice Address - Phone:509-946-7931
Practice Address - Fax:509-946-7223
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60115658363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0259156OtherLABOR & INDUSTRIES
WA8886544Medicare PIN