Healthcare Provider Details

I. General information

NPI: 1558939280
Provider Name (Legal Business Name): MARY SANTOVITO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9113 61ST AVENUE CT E
PUYALLUP WA
98371-7117
US

IV. Provider business mailing address

9113 61ST AVENUE CT E
PUYALLUP WA
98371-7117
US

V. Phone/Fax

Practice location:
  • Phone: 253-445-5209
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number00090082
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number00090082
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: