Provider Demographics
NPI:1265588917
Name:MOERKE, TAMMI RENEE (LMP)
Entity type:Individual
Prefix:MS
First Name:TAMMI
Middle Name:RENEE
Last Name:MOERKE
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 1:493 COUSINS RD
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-9057
Mailing Address - Country:US
Mailing Address - Phone:360-584-5387
Mailing Address - Fax:
Practice Address - Street 1:204 PINEHURST DRIVE SW SUITE #103
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501
Practice Address - Country:US
Practice Address - Phone:360-352-8112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist