Healthcare Provider Details

I. General information

NPI: 1780868083
Provider Name (Legal Business Name): MAGGIE I WESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E PIONEER AVE
PUYALLUP WA
98372-3265
US

IV. Provider business mailing address

325 E PIONEER AVE
PUYALLUP WA
98372-3265
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-8548
  • Fax: 253-697-8590
Mailing address:
  • Phone: 253-697-8548
  • Fax: 253-697-8590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberRC00058233
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: