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General NPI Number Information
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NPI Number | 1043865421
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Entity Type | Individual
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Provider Name | MARINA VIKTOROVNA DOLMATOVA ARNP
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Gender | Female
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Dates
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Enumeration Date | 08/02/2019
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 2622 S MERIDIAN
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City | PUYALLUP
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State | WA
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Zip | 98373-1500
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Country | US
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Telephone | 253-841-2453
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Fax | 253-840-5519
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Provider Business Mailing Address
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Address Line | 1793 13TH ST SE
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City | SALEM
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State | OR
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Zip | 97302-2541
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Country | US
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Telephone | 503-362-8385
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Fax | 503-362-8435
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | RN60656201
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP61194717
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License Number State | WA
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