Provider Demographics
NPI:1194165787
Name:ENDERLEIN, MARY-CLAYTON PEARCE (ARNP)
Entity type:Individual
Prefix:DR
First Name:MARY-CLAYTON
Middle Name:PEARCE
Last Name:ENDERLEIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5371
Mailing Address - Street 2:M/S RC 411
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5005
Mailing Address - Country:US
Mailing Address - Phone:206-987-1387
Mailing Address - Fax:206-985-3159
Practice Address - Street 1:4300 ROOSEVELT WAY NE
Practice Address - Street 2:RC 411
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4718
Practice Address - Country:US
Practice Address - Phone:206-987-1387
Practice Address - Fax:206-987-3159
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60079150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily