Provider Demographics
NPI:1871702423
Name:TVEIDT, CARRIE LEE (LMP)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:LEE
Last Name:TVEIDT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:LEE
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:9901 NE 7TH AVE STE B232
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-4538
Mailing Address - Country:US
Mailing Address - Phone:360-573-3500
Mailing Address - Fax:360-573-3510
Practice Address - Street 1:9901 NE 7TH AVE STE B232
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-4538
Practice Address - Country:US
Practice Address - Phone:360-573-3500
Practice Address - Fax:360-573-3510
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016922171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor