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Individual

DR. MARY JANELLE VANCLEAVE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
21601 76TH AVE W, EDMONDS, WA 98026-7507
(425) 640-4000
(425) 640-4931
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 215-3354

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD00048353
WA
208M00000X
Hospitalist Physician
Primary
MD00048353
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1508949991
WA
Enumeration date
10/23/2006
Last updated
10/02/2023
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