Healthcare Provider Details

I. General information

NPI: 1093912891
Provider Name (Legal Business Name): MRS. JOAN MARIE DAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5318 CHIEF BROWN LN
DARRINGTON WA
98241-9420
US

IV. Provider business mailing address

5318 CHIEF BROWN LN
DARRINGTON WA
98241-9420
US

V. Phone/Fax

Practice location:
  • Phone: 360-436-2845
  • Fax: 360-436-0242
Mailing address:
  • Phone: 360-436-2845
  • Fax: 360-436-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberRC00016201
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: