# PIONEER FAMILY PRACTICE, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205965365
- **Authorized official:** DIANE M TAYLOR (BUSINESS MANAGER)
- **Authorized official phone:** (360) 413-8617

## Contact information

- **Practice address:** 5130 CORPORATE CENTER CT SE, LACEY, WA 98503-5957
- **Practice address phone:** (360) 413-8600
- **Practice address fax:** (360) 413-8822
- **Mailing address:** 5130 CORPORATE CENTER CT SE, LACEY, WA 98503-5957
- **Mailing address phone:** (360) 413-8600
- **Mailing address fax:** (360) 413-8822

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/05/2007
- **Last updated:** 03/07/2023