Healthcare Provider Details

I. General information

NPI: 1144842311
Provider Name (Legal Business Name): MARY E KEITH DRAPER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY E KEITH

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3603 56TH AVE SW
SEATTLE WA
98116-3136
US

IV. Provider business mailing address

PO BOX 80847
SEATTLE WA
98108-0847
US

V. Phone/Fax

Practice location:
  • Phone: 206-793-7391
  • Fax:
Mailing address:
  • Phone: 206-793-7391
  • Fax: 206-708-1823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN00138765
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: