Provider Demographics
NPI:1477166031
Name:TUIFUA, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TUIFUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21649 94TH PL S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-1901
Mailing Address - Country:US
Mailing Address - Phone:206-886-1611
Mailing Address - Fax:253-277-0290
Practice Address - Street 1:21649 94TH PL S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-1901
Practice Address - Country:US
Practice Address - Phone:206-886-1611
Practice Address - Fax:253-277-0290
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60946559163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse