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General NPI Number Information
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NPI Number | 1689965063
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Entity Type | Organization
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Legal Business Name | WASHINGTON STATE DEPARTMENT OF CORRECTIONS MISSION CREEK CORRECTIONS C
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Dates
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Enumeration Date | 04/20/2011
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 3420 NE SAND HILL ROAD
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City | BELFAIR
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State | WA
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Zip | 98528
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Country | US
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Telephone | 360-277-2400
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Fax | 360-277-2454
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Provider Business Mailing Address
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Address Line | PO BOX 41100, MAIL STOP 41100
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City | OLYMPIA
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State | WA
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Zip | 98504-1100
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Country | US
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Telephone | 360-725-8213
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Fax | 360-586-1320
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | MARYANN CURL
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Credential | M.D.
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Telephone | 509-318-3498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number |
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License Number State |
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