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General NPI Number Information
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NPI Number | 1891333613
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Entity Type | Organization
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Legal Business Name | MISS MARY COMMUNITY DEVELOPMENT
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 1630 TRENTON AVENUE APT 10
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City | BREMERTON
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State | WA
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Zip | 98310
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Country | US
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Telephone | 360-908-8536
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Fax |
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Provider Business Mailing Address
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Address Line | 1630 TRENTON AVENUE APT 10
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City | BREMERTON
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State | WA
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Zip | 98310
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Country | US
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Telephone | 360-908-8536
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | MS. MARIAN SANDERS
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Credential |
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Telephone | 360-908-8536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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