Maryann Elizabeth Iversen, SUDPT

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

CO61285882 Issued in WA

Practice address

30620 Pacific Hwy S Ste 107
Federal Way, WA 98003-4888

Phone

(253) 941-7555

NPI assigned

Apr 5, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Maryann Elizabeth Lillie Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nancy Lee Stark Dba Intercept Associates

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Federal Way, WA
  • NPI 1932258225
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1467193458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30620 PACIFIC HWY S STE 107",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980034888",
            "telephone_number": "253-941-7555",
            "fax_number": "253-941-0652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30620 PACIFIC HWY S STE 107",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980034888",
            "telephone_number": "253-941-7555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVERSEN",
        "first_name": "MARYANN",
        "middle_name": "ELIZABETH",
        "credential": "SUDPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WA",
            "license": "CO61285882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARYANN",
            "last_name": "LILLIE",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sidikat Ismail
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• Faten Itani
• Vera Ivanova
• Brianna Kei Ives, LMP
• Claire Iwata, DPT
• Nicole Iwuoha-Thomas, ARNP
• Alison Esther Izquierdo, NP-C
• J Martini DMD PLLC

• Student in an Organized Health Care Education/Training Program in Federal Way, WA
• Providers in Federal Way, WA by specialty
• Student in an Organized Health Care Education/Training Program in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.