Individual
MARY HEADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
450 S KITSAP BLVD STE 210, PORT ORCHARD, WA 98366-3738
(360) 874-5900
Mailing address
450 S KITSAP BLVD STE 210, PORT ORCHARD, WA 98366-3738
(360) 874-5900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OP60947864
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2138624
—
WA
Enumeration date
04/06/2016
Last updated
12/04/2020
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