Healthcare Provider Details

I. General information

NPI: 1205652732
Provider Name (Legal Business Name): MOUNTAINS MEET MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2024
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 BRIDGEPORT WAY W
UNIVERSITY PLACE WA
98466-4201
US

IV. Provider business mailing address

4401 BRIDGEPORT WAY W
UNIVERSITY PLACE WA
98466-4201
US

V. Phone/Fax

Practice location:
  • Phone: 253-237-2169
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAURA MARSHALL
Title or Position: MANAGING MEMBER
Credential: DO
Phone: 253-237-2169