Provider Demographics
NPI:1629415112
Name:DREWERY /JACKSON, MARILAND ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:MARILAND
Middle Name:ELIZABETH
Last Name:DREWERY /JACKSON
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 1:2744 AILPINE DR SE
Mailing Address - Street 2:
Mailing Address - City:AURBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002
Mailing Address - Country:US
Mailing Address - Phone:253-333-9255
Mailing Address - Fax:253-333-7913
Practice Address - Street 1:2744 AILPINE DR SE
Practice Address - Street 2:
Practice Address - City:AURBURN
Practice Address - State:WA
Practice Address - Zip Code:98002
Practice Address - Country:US
Practice Address - Phone:253-333-9255
Practice Address - Fax:253-333-7913
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA494200376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide