Individual
MARYANN ELIZABETH IVERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUDPT
Contact information
Practice address
30620 PACIFIC HWY S STE 107, FEDERAL WAY, WA 98003-4888
(253) 941-7555
Mailing address
30620 PACIFIC HWY S STE 107, FEDERAL WAY, WA 98003-4888
(253) 941-7555
(253) 941-0652
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
CO61285882
WA
Other
Enumeration date
04/05/2022
Last updated
04/05/2022
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