Healthcare Provider Details

I. General information

NPI: 1912459199
Provider Name (Legal Business Name): MARIE LEANN FIERRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 2ND ST SE
YELM WA
98597-7638
US

IV. Provider business mailing address

508 2ND ST SE
YELM WA
98597-7638
US

V. Phone/Fax

Practice location:
  • Phone: 253-282-6996
  • Fax:
Mailing address:
  • Phone: 253-282-6996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: