| NPI | 1194973628 |
|---|---|
| Former Legal Business Name | MARYS CORNER MEDICAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | KIMBERLY HOPE INGLIS Office Manager 360-262-3966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP00000823) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00039760) |
| 261QR1300X Clinic/Center, Rural Health (Licence: WA OP00000823) | |
| 261QR1300X Clinic/Center, Rural Health (Licence: WA MD00039760) | |
| 261QR1300X Clinic/Center, Rural Health (Licence: WA AP30005675) | |
| 261QR1300X Clinic/Center, Rural Health (Licence: WA PA0004588) | |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA10004588) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP30005675) | |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2012-04-30 |