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Individual

MARY J DYKES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ARNP

Contact information

Practice address
971 11TH AVE, LONGVIEW, WA 98632-2503
(360) 577-1771
(360) 423-1405
Mailing address
971 11TH AVE, LONGVIEW, WA 98632-2503
(360) 577-1771
(360) 423-1405

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
AP30003151
WA
208000000X
Pediatrics Physician
RN00070552
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
9609876
WA
Enumeration date
06/05/2006
Last updated
04/26/2012
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