Provider Demographics
NPI:1164817672
Name:MIRES, RIKKI
Entity Type:Individual
Prefix:
First Name:RIKKI
Middle Name:
Last Name:MIRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RIKKI
Other - Middle Name:
Other - Last Name:UNION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27606 PACIFIC HWY S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-3402
Mailing Address - Country:US
Mailing Address - Phone:509-200-8276
Mailing Address - Fax:
Practice Address - Street 1:27606 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-3402
Practice Address - Country:US
Practice Address - Phone:509-200-8276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist