Healthcare Provider Details

I. General information

NPI: 1861667305
Provider Name (Legal Business Name): MARY L FLICK RN, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 MONROE ST
PORT TOWNSEND WA
98368-5709
US

IV. Provider business mailing address

242 MONROE ST
PORT TOWNSEND WA
98368-5709
US

V. Phone/Fax

Practice location:
  • Phone: 360-385-5658
  • Fax:
Mailing address:
  • Phone: 360-385-5658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN00136754
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30005576
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: