Individual
MERCEDES M CARBONEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NA-R
Contact information
Practice address
3212 LIBBY RD NE, OLYMPIA, WA 98506-2985
(360) 357-3918
Mailing address
3212 LIBBY RD NE, OLYMPIA, WA 98506-2985
(360) 357-3918
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
150500
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
453154
SOCIAL SERVICE PAYMENT SYSTEM
WA
Enumeration date
08/27/2013
Last updated
08/27/2013
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