Provider Demographics
NPI:1336292648
Name:FIELDS, MIRIAM LOUISE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:LOUISE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:MIMI
Other - Middle Name:L
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:6035 WOODARD BAY RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-1543
Mailing Address - Country:US
Mailing Address - Phone:360-754-1307
Mailing Address - Fax:
Practice Address - Street 1:6035 WOODARD BAY RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-1543
Practice Address - Country:US
Practice Address - Phone:360-754-1307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000257872083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1108083Medicaid
WABF2176279OtherDEA
WABF2176279OtherDEA