Provider Demographics
NPI:1447575378
Name:HOVELSON, MARI ANN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:MARI
Middle Name:ANN
Last Name:HOVELSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 STATE AVE NE STE B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4764
Mailing Address - Country:US
Mailing Address - Phone:360-870-4212
Mailing Address - Fax:
Practice Address - Street 1:2222 STATE AVE NE STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4764
Practice Address - Country:US
Practice Address - Phone:360-870-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-03
Last Update Date:2010-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00016673172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker