Provider Demographics
NPI:1518907666
Name:VINSON, TONI LYNNE (LMP)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:LYNNE
Last Name:VINSON
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 1:14334 GLENWOOD RD SW
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-7770
Mailing Address - Country:US
Mailing Address - Phone:360-876-4901
Mailing Address - Fax:360-876-0781
Practice Address - Street 1:3015 BRIDGEPORT WAY W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4699
Practice Address - Country:US
Practice Address - Phone:253-534-9854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012110174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist