Healthcare Provider Details

I. General information

NPI: 1689550279
Provider Name (Legal Business Name): MARIANELA D HURLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 15TH AVE SE
PUYALLUP WA
98372-3715
US

IV. Provider business mailing address

3317 SHORECLIFF DR NE
TACOMA WA
98422-2302
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-4000
  • Fax:
Mailing address:
  • Phone: 314-939-4340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61269001
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: