Provider Demographics
NPI:1649420266
Name:WAKEFIELD, MARIE W (ND, LM)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:W
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:ND, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6913 227TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-5841
Mailing Address - Country:US
Mailing Address - Phone:206-356-7299
Mailing Address - Fax:
Practice Address - Street 1:5302 104TH ST E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98446
Practice Address - Country:US
Practice Address - Phone:206-356-7299
Practice Address - Fax:253-248-0153
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001290175F00000X
WAMW00000290176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7127723Medicaid