Provider Demographics
NPI:1790012128
Name:VERD, MARY K (LMP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:VERD
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 1:260 W MOORE ST
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-1039
Mailing Address - Country:US
Mailing Address - Phone:360-855-3000
Mailing Address - Fax:360-855-3000
Practice Address - Street 1:260 W MOORE ST
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1039
Practice Address - Country:US
Practice Address - Phone:360-855-3000
Practice Address - Fax:360-855-3000
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018114174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist