Provider Demographics
NPI:1295498749
Name:CLEMENSHAW-DAHL, TAMI JO (CMA)
Entity type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:JO
Last Name:CLEMENSHAW-DAHL
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:JO
Other - Last Name:CLEMENSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMA
Mailing Address - Street 1:4526 FEDERAL AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2132
Mailing Address - Country:US
Mailing Address - Phone:425-349-6200
Mailing Address - Fax:
Practice Address - Street 1:4526 FEDERAL AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2132
Practice Address - Country:US
Practice Address - Phone:425-349-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACM60396222374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician