Healthcare Provider Details

I. General information

NPI: 1639722697
Provider Name (Legal Business Name): MARY MARGARET THOMAS RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 5TH AVE STE 2300
SEATTLE WA
98104-7041
US

IV. Provider business mailing address

701 5TH AVE STE 2300
SEATTLE WA
98104-7041
US

V. Phone/Fax

Practice location:
  • Phone: 206-258-6039
  • Fax: 206-701-9452
Mailing address:
  • Phone: 206-258-6039
  • Fax: 206-701-9452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number95112858
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number4704340686
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number132128
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number60158960
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: