Provider Demographics
NPI:1508030180
Name:FLOURNOY, PAULINE (CARE GIVER)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:FLOURNOY
Suffix:
Gender:F
Credentials:CARE GIVER
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28121 14TH AVE E
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:WA
Mailing Address - Zip Code:98580
Mailing Address - Country:US
Mailing Address - Phone:253-843-2989
Mailing Address - Fax:253-843-3087
Practice Address - Street 1:28121 14TH AVE E
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:WA
Practice Address - Zip Code:98580
Practice Address - Country:US
Practice Address - Phone:253-843-2989
Practice Address - Fax:253-843-3087
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA138000311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home