Basic Information
| Provider Information | |||||||||
| NPI: | 1871030825 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WORK | ||||||||
| FirstName: | TOD | ||||||||
| MiddleName: | PIERSON | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11306 BRIDGEPORT WAY SW STE D | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984993037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607520518 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22014 7TH AVE S STE 105B | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981986235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533476099 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2017 | ||||||||
| LastUpdateDate: | 12/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP60726755 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | AP11102 | 01 | AZ | ADVANCED NURSE PRACTITIONER LICENSE | OTHER | AP60726755 | 01 | WA | ADVANCED NURSE PRACTITIONER LICENSE | OTHER |