Healthcare Provider Details

I. General information

NPI: 1093829541
Provider Name (Legal Business Name): MS. MARY LOUISE SOEHNLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 VETERANS DR SW
TACOMA WA
98493-0003
US

IV. Provider business mailing address

5218 65TH AVE SE
LACEY WA
98513-5059
US

V. Phone/Fax

Practice location:
  • Phone: 253-582-8440
  • Fax: 253-589-4087
Mailing address:
  • Phone: 360-413-7642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberAP30001654
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: