Provider Demographics
NPI:1073336616
Name:IDES, MARYJANE FAITH
Entity type:Individual
Prefix:
First Name:MARYJANE
Middle Name:FAITH
Last Name:IDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 22ND AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-2257
Mailing Address - Country:US
Mailing Address - Phone:360-640-9977
Mailing Address - Fax:
Practice Address - Street 1:2502 22ND AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-2257
Practice Address - Country:US
Practice Address - Phone:360-640-9977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula