Basic Information
Provider Information
NPI: 1861638835
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MEYER
FirstName: ANNE
MiddleName: MARIE
NamePrefix: MISS
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11102 SUNRISE BLVD E
Address2: SUITE 103
City: PUYALLUP
State: WA
PostalCode: 98374
CountryCode: US
TelephoneNumber: 2538488797
FaxNumber: 2538450100
Practice Location
Address1: 11102 SUNRISE BLVD E
Address2: SUITE 103
City: PUYALLUP
State: WA
PostalCode: 98374
CountryCode: US
TelephoneNumber: 2538488797
FaxNumber: 2538450100
Other Information
ProviderEnumerationDate: 12/22/2008
LastUpdateDate: 09/16/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAP60105484WAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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