Provider Demographics
NPI:1265563035
Name:WILLIAMS, TONIA MARIE (LMP)
Entity type:Individual
Prefix:
First Name:TONIA
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5519 NE 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7803
Mailing Address - Country:US
Mailing Address - Phone:360-513-2484
Mailing Address - Fax:
Practice Address - Street 1:1701 BROADWAY ST # 370
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3436
Practice Address - Country:US
Practice Address - Phone:360-513-2484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018210174400000X
OR10832174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist