Healthcare Provider Details

I. General information

NPI: 1699441642
Provider Name (Legal Business Name): MARILYN SELL CO61174321
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 08/19/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24823 PACIFIC HWY S
KENT WA
98032-5478
US

IV. Provider business mailing address

24823 PACIFIC HWY S
KENT WA
98032-5478
US

V. Phone/Fax

Practice location:
  • Phone: 253-681-0010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberCO61174321
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: