MEDICARE: MRS. MAUREEN LYNN POMIETTO R.N., M.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	RN00076414	WA

General Provider Information

NPI Number	:	1346673662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAUREEN LYNN POMIETTO R.N., M.N.

Provider Business Mailing Address
First Line	:	86 SCHOOL RD
Second Line	:
City	:	LOPEZ ISLAND
State	:	WA
Zip	:	98261-8000
Country	:	US
Telephone Number	:	360-468-2201
Fax Number	:	360-468-2235

Provider Business Practice Location Address
First Line	:	86 SCHOOL RD
Second Line	:
City	:	LOPEZ ISLAND
State	:	WA
Zip	:	98261-8000
Country	:	US
Telephone Number	:	360-468-2201
Fax Number	:	360-468-2235

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2013
Last Update Date	:	08/11/2013

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