Provider Demographics
NPI:1285655779
Name:DATA, MARY KATHLEEN (ND)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHLEEN
Last Name:DATA
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:DATA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:6111 20TH ST E
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-2098
Mailing Address - Country:US
Mailing Address - Phone:253-926-2222
Mailing Address - Fax:
Practice Address - Street 1:6111 20TH ST E
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-2098
Practice Address - Country:US
Practice Address - Phone:253-926-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00000541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine