Provider Demographics
NPI:1154550580
Name:MEYERQUINONEZ, MARY L (RN, LMP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:L
Last Name:MEYERQUINONEZ
Suffix:
Gender:F
Credentials:RN, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 470
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-0470
Mailing Address - Country:US
Mailing Address - Phone:509-307-5362
Mailing Address - Fax:509-965-9175
Practice Address - Street 1:7300 SADDLE BROOK DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-5413
Practice Address - Country:US
Practice Address - Phone:509-307-5362
Practice Address - Fax:509-965-9175
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00135775163WM1400X
WAMA60089164225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist