Provider Demographics
NPI:1316158108
Name:PFEIFFER, MARY ELLEN (BA, LMP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:PFEIFFER
Suffix:
Gender:F
Credentials:BA, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7621 171ST AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-7169
Mailing Address - Country:US
Mailing Address - Phone:253-863-4714
Mailing Address - Fax:
Practice Address - Street 1:7621 171ST AVENUE CT E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-7169
Practice Address - Country:US
Practice Address - Phone:253-863-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011816174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0100617OtherLABOR AND INDUSTRIES