Paula J Rider, LMP
Individual provider Active NPI Specialist · Lake Tapps, WA
NPI 1356599609 · NPPES record last updated Aug 28, 2008
Key facts
- NPI
- 1356599609
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- MA00023762 (WA)
- Practice address
- 3920 W Tapps Dr E
Lake Tapps, WA 98391-9176 - Phone
- (253) 310-5333
- Fax
- (253) 826-4792
- NPI assigned
- Aug 28, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA00023762 | WA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake Tapps Family Medicine, PLLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA00023762 | WA | Yes |
Addresses
Primary practice location
3920 W Tapps Dr E
Lake Tapps, WA 98391-9176
Mailing address
PO Box 610
Sumner, WA 98390-0110
Phone (253) 310-5333
Other providers in Lake Tapps, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.