| Organization Name: | TRAVELING PAIN MANAGEMENT DOCTORS PSC |
| NPI Number: | 1356682470 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TRACI M MANCUSO (FAMILY NURSE PRACTITIONER) |
| Mailing Address: | 21234 Se 273rd Pl Maple Valley |
| State: | WA US |
| Postal Code: | 980383350 |
| Phone Number: | 5093896945 |
| Fax Number: | |
| NPI Enumeration Date: | 03/14/2013 |
| NPI Last Update Date: | 02/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP30006855 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |