Provider Demographics
NPI:1336395896
Name:MONTSTREAM, MIHEE MICKEY (ARNP)
Entity Type:Individual
Prefix:
First Name:MIHEE
Middle Name:MICKEY
Last Name:MONTSTREAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 S J ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4933
Mailing Address - Country:US
Mailing Address - Phone:253-426-6691
Mailing Address - Fax:253-426-6492
Practice Address - Street 1:1717 S J ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4933
Practice Address - Country:US
Practice Address - Phone:253-426-6691
Practice Address - Fax:253-426-6492
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00127876163W00000X
WAAP60039532363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0279449OtherSTATE L&I
WA8948258OtherCRIME VICTIMS
WA0279447OtherSTATE L&I
WA0287255OtherSTATE L&I
WA0287481OtherSTATE L&I
WA9658444Medicaid
WA0278223OtherSTATE L&I
WA0238994OtherSTATE L&I
WA0278232OtherSTATE L&I
WA0291785OtherSTATE L&I
WA0238994OtherL&I
WA0278223OtherSTATE L&I