Organization
PINE FAMILY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LOU PINE PAC (OWNER/PROVIDER)
(509) 836-2367
Entity
Organization
Contact information
Practice address
2240 E LINCOLN AVE, SUNNYSIDE, WA 98944-2487
(509) 836-2367
Mailing address
203 SW MALIBU DR, PROSSER, WA 99350-9419
(509) 836-2367
(855) 784-6425
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2109936
—
WA
Enumeration date
02/26/2019
Last updated
02/26/2019
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