Provider Demographics
NPI:1780643353
Name:WEENIKE, MARY M (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:M
Last Name:WEENIKE
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:1660 S COLUMBIAN WAY
Mailing Address - Street 2:S-111-DERM
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:206-764-2305
Mailing Address - Fax:206-764-2689
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:MAIL STOP S-111-DERM
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-764-2305
Practice Address - Fax:206-764-2689
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP30004313363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health