Provider Demographics
NPI:1447223235
Name:LOPES, MARY (BSN, ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LOPES
Suffix:
Gender:F
Credentials:BSN, ARNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 642302
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99164-2302
Mailing Address - Country:US
Mailing Address - Phone:509-335-3575
Mailing Address - Fax:
Practice Address - Street 1:NE 1125 WASHINGTON ST
Practice Address - Street 2:WASHINGTON STATE UNIVERSITY
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99164-0001
Practice Address - Country:US
Practice Address - Phone:509-335-3575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000707363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9607516Medicaid
WAS54569Medicare UPIN