Provider Demographics
NPI:1154464725
Name:MAINZER-CARTER, MARGARET M (LMP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:MAINZER-CARTER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:M
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-0236
Mailing Address - Country:US
Mailing Address - Phone:360-629-7145
Mailing Address - Fax:360-629-9985
Practice Address - Street 1:30327 56TH AVE NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-7157
Practice Address - Country:US
Practice Address - Phone:360-629-7145
Practice Address - Fax:360-629-9985
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009088174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00009088OtherSTATE OF WA LICENSE NO.
WA106762OtherL&I PROVIDER NO.
CA0534OtherREGENCE PROVIDER NO.