Provider Demographics
NPI:1912459199
Name:PEREZ, MARIE LEANN
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:LEANN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-7638
Mailing Address - Country:US
Mailing Address - Phone:253-282-6996
Mailing Address - Fax:
Practice Address - Street 1:508 2ND ST SE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7638
Practice Address - Country:US
Practice Address - Phone:253-282-6996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other