Provider Demographics
NPI:1639221542
Name:MCENIRY, DENISE L (LMP)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:L
Last Name:MCENIRY
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:PO BOX 651
Mailing Address - Street 2:
Mailing Address - City:RAVENSDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98051-0651
Mailing Address - Country:US
Mailing Address - Phone:206-354-5300
Mailing Address - Fax:360-886-1611
Practice Address - Street 1:28610 MAPLE VALLEY BLACK DIAMOND RD SE STE 120
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8199
Practice Address - Country:US
Practice Address - Phone:206-354-5300
Practice Address - Fax:360-886-1611
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00003012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist