Provider Demographics
NPI:1790002475
Name:TUTTLE, TAMMY MARIE (LPM)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:MARIE
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:LPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E MAYFAIR CT APT 36
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5909
Mailing Address - Country:US
Mailing Address - Phone:509-951-7304
Mailing Address - Fax:
Practice Address - Street 1:515 E. FRANCES AVE STE#8
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205
Practice Address - Country:US
Practice Address - Phone:509-326-5762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60300058311174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALUCKYDOGTUTTMedicaid