Individual
MARY VAN DE VEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.P.
Contact information
Practice address
23619 14TH AVE S, DES MOINES, WA 98198-7402
(206) 878-1892
Mailing address
23619 14TH AVE S, DES MOINES, WA 98198-7402
(206) 878-1892
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA 60016934
WA
Other
Enumeration date
07/16/2008
Last updated
07/16/2008
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