Provider Demographics
NPI:1639658578
Name:MATHEWS, TONYA KATHLEEN (BSN, RN-BC, CFCS)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:KATHLEEN
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:BSN, RN-BC, CFCS
Other - Prefix:MS
Other - First Name:TONYA
Other - Middle Name:KATHLEEN
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1605 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:LA CENTER
Mailing Address - State:WA
Mailing Address - Zip Code:98629
Mailing Address - Country:US
Mailing Address - Phone:360-901-2412
Mailing Address - Fax:
Practice Address - Street 1:1605 W 15TH ST
Practice Address - Street 2:
Practice Address - City:LA CENTER
Practice Address - State:WA
Practice Address - Zip Code:98629
Practice Address - Country:US
Practice Address - Phone:360-433-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201391649RN163W00000X
WARN60410831163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse