Provider Demographics
NPI:1700286440
Name:COFREROS, MARY JO PATINO (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY JO
Middle Name:PATINO
Last Name:COFREROS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7224 43RD ST W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4314
Mailing Address - Country:US
Mailing Address - Phone:253-507-9452
Mailing Address - Fax:
Practice Address - Street 1:7224 43RD ST W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4314
Practice Address - Country:US
Practice Address - Phone:253-507-9452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60036901163W00000X
WAAP60737794363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse