Individual
MAN LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
1450 5TH ST SE STE 3400, PUYALLUP, WA 98372-4638
(253) 697-4740
(253) 697-4744
Mailing address
1450 5TH ST SE STE 3400, PUYALLUP, WA 98372-4638
(253) 697-4740
(253) 697-4744
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
61149271
WA
Other
Enumeration date
02/15/2021
Last updated
02/15/2021
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