Basic Information
| Provider Information | |||||||||
| NPI: | 1811309560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PUHR | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | IRENE | ||||||||
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| Credential: | BSN,MN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 746 | ||||||||
| Address2: | |||||||||
| City: | COUPEVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982399556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606784440 | ||||||||
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| Practice Location | |||||||||
| Address1: | 77 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | COUPEVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982399556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606784440 | ||||||||
| FaxNumber: | 3606789244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2014 | ||||||||
| LastUpdateDate: | 06/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | AP60474383 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.