Provider Demographics
NPI:1265568133
Name:ROLOFF, TAMRA KAY (LM, CPM)
Entity type:Individual
Prefix:
First Name:TAMRA
Middle Name:KAY
Last Name:ROLOFF
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1061
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:WA
Mailing Address - Zip Code:98631-1061
Mailing Address - Country:US
Mailing Address - Phone:509-220-9915
Mailing Address - Fax:
Practice Address - Street 1:901 LAKEVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:ILWACO
Practice Address - State:WA
Practice Address - Zip Code:98624
Practice Address - Country:US
Practice Address - Phone:509-220-9915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW00000283176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR279358Medicaid
WA7122286Medicaid