Basic Information
Provider Information | |||||||||
NPI: | 1841450699 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CUMMINGS | ||||||||
FirstName: | THOMAS | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 15214 CANYON RD E | ||||||||
Address2: | STE 120 | ||||||||
City: | PUYALLUP | ||||||||
State: | WA | ||||||||
PostalCode: | 983757472 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2535394200 | ||||||||
FaxNumber: | 2535396025 | ||||||||
Practice Location | |||||||||
Address1: | 1708 YAKIMA AVE | ||||||||
Address2: | SUITE 112 | ||||||||
City: | TACOMA | ||||||||
State: | WA | ||||||||
PostalCode: | 984055307 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2534266301 | ||||||||
FaxNumber: | 2534266344 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/16/2008 | ||||||||
LastUpdateDate: | 11/08/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN00168185 | WA | N |   | Nursing Service Providers | Registered Nurse |   | 363LF0000X | AP60040725 | WA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 0248132 | 01 | WA | STATE L&I | OTHER | 0255761 | 01 | WA | STATE L&I | OTHER | 0240971 | 01 | WA | STATE L&I | OTHER | 0239883 | 01 | WA | STATE L&I | OTHER | 0239884 | 01 | WA | STATE L&I | OTHER |