Individual
MARY LOU MCCORMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
19 LAKES STREET, NESPELEM, WA 99155
(509) 634-2900
Mailing address
PO BOX 71, NESPELEM, WA 99155-0071
(509) 634-2900
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
60802429
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60802429
RN
WA
Enumeration date
01/16/2018
Last updated
01/16/2018
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