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Organization

PIONEER FAMILY PRACTICE, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DIANE M TAYLOR (BUSINESS MANAGER)
(360) 413-8617
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
02
CORPORATE
WA
01
1205965365
NPI
WA
01
147741
LABOR AND INUDUSTRY
WA
05
7105869
WA
Enumeration date
03/05/2007
Last updated
03/07/2023
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