Individual
MS. MARY ALICE MCCUBBINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
971 11TH AVE, LONGVIEW, WA 98632
(360) 423-6140
(360) 423-1405
Mailing address
971 11TH AVE, LONGVIEW, WA 98632-2503
(360) 423-6140
(360) 423-1405
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
AP60567776
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2047772
—
WA
Enumeration date
12/01/2005
Last updated
06/06/2018
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