Provider Demographics
NPI:1265150379
Name:MAPLE VALLEY MOVEMENT NEUROLOGY, PLLC
Entity type:Organization
Organization Name:MAPLE VALLEY MOVEMENT NEUROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LELIA
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:425-200-4546
Mailing Address - Street 1:22620 SE 216TH PL STE D
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-6346
Mailing Address - Country:US
Mailing Address - Phone:425-200-4546
Mailing Address - Fax:425-523-9167
Practice Address - Street 1:22620 SE 216TH PL STE E
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-6346
Practice Address - Country:US
Practice Address - Phone:425-200-4546
Practice Address - Fax:425-523-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty