Provider Demographics
NPI:1942408224
Name:HENNE, TAMELA MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:TAMELA
Middle Name:MARIE
Last Name:HENNE
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 1:3309 TACOMA ST
Mailing Address - Street 2:
Mailing Address - City:UNION GAP
Mailing Address - State:WA
Mailing Address - Zip Code:98903-1970
Mailing Address - Country:US
Mailing Address - Phone:509-307-5005
Mailing Address - Fax:509-469-0467
Practice Address - Street 1:106 S 7TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3306
Practice Address - Country:US
Practice Address - Phone:509-307-5005
Practice Address - Fax:509-469-0467
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023098174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0214628OtherWA STATE L&I PROVIDER #