Provider Demographics
NPI:1609469782
Name:KERPAN, TANIA
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:KERPAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 114TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-4787
Mailing Address - Country:US
Mailing Address - Phone:425-750-8961
Mailing Address - Fax:
Practice Address - Street 1:12138 MUKILTEO SPEEDWAY STE M103
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5738
Practice Address - Country:US
Practice Address - Phone:425-750-8961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist