Provider Demographics
NPI:1174562664
Name:THURMAN, MICHELLE MARGARET HANWAY (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARGARET HANWAY
Last Name:THURMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARGARET
Other - Last Name:HANWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-0137
Mailing Address - Country:US
Mailing Address - Phone:253-697-5502
Mailing Address - Fax:253-697-5510
Practice Address - Street 1:16515 MERIDIAN E
Practice Address - Street 2:SUITE 104A
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6251
Practice Address - Country:US
Practice Address - Phone:253-697-3030
Practice Address - Fax:253-697-8190
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7247466OtherAETNA PROVIDER NUMBER
WA8374175Medicaid
WA98375B014OtherTRICARE PROVIDER NUMBER
WA911203494AAOtherKPS PROVIDER NUMBER
WA1896THOtherREGENCE RIDER NUMBER
WA0171135OtherL & I PROVIDER NUMBER
WA7247466OtherAETNA PROVIDER NUMBER