Healthcare Provider Details

I. General information

NPI: 1659766210
Provider Name (Legal Business Name): MARY WHITNEY PRICE M.S., R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PONDEROSA CT APT 102
MOSCOW ID
83843-3451
US

IV. Provider business mailing address

401 PONDEROSA CT APT 102
MOSCOW ID
83843-3451
US

V. Phone/Fax

Practice location:
  • Phone: 509-926-4984
  • Fax:
Mailing address:
  • Phone: 509-926-4984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60337048
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN-46553
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0052230
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberN-46553
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN60337048
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: