Individual
PRIM PREY KY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1350 MARVIN RD NE STE D, LACEY, WA 98516-3877
(888) 227-3312
(360) 413-6509
Mailing address
PO BOX 2928, PORTLAND, OR 97208-2928
(425) 207-5155
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60763223
WA
Other
Enumeration date
03/09/2018
Last updated
08/26/2024
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