Provider Demographics
NPI:1629593728
Name:DAVIS-MUNN, TINA MAE (RN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MAE
Last Name:DAVIS-MUNN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 6TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-1866
Mailing Address - Country:US
Mailing Address - Phone:360-265-1666
Mailing Address - Fax:350-813-1382
Practice Address - Street 1:345 6TH ST, SUITE 300
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337
Practice Address - Country:US
Practice Address - Phone:360-265-1666
Practice Address - Fax:350-813-1382
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00084757163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse