Provider Demographics
NPI:1447875083
Name:TATUM, ANDREW
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:TATUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111297
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98411-1297
Mailing Address - Country:US
Mailing Address - Phone:253-471-0890
Mailing Address - Fax:253-284-0316
Practice Address - Street 1:4301 S PINE ST STE 112
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7204
Practice Address - Country:US
Practice Address - Phone:253-471-0890
Practice Address - Fax:253-284-0316
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246YR1600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationRegistered Record Administrator
No171M00000XOther Service ProvidersCase Manager/Care Coordinator