Mary Lou McCormack, RN
Individual provider Active NPI General Practice Registered Nurse · Nespelem, WA
NPI 1790293447 · NPPES record last updated Jan 16, 2018
Key facts
- NPI
- 1790293447
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Registered Nurse 163WG0000X
- License
- 60802429 (WA)
- Practice address
- 19 Lakes Street
Nespelem, WA 99155 - Phone
- (509) 634-2900
- NPI assigned
- Jan 16, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60802429 | WA | MD | General Practice Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | 60802429 | WA | Yes |
Addresses
Primary practice location
19 Lakes Street
Nespelem, WA 99155
Mailing address
PO Box 71
Nespelem, WA 99155-0071
Phone (509) 634-2900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60802429 | Other | WA | RN |
Other providers in Nespelem, WA
- Laurae A Macclain
- Gurpreet Kaur Mann
- Richard A Manning
- Nadine Matthews
- Patricia Ann Maxwell
- Christopher Patrick McCuen
- Gloria Means
- Joleen Anne Mollenberg
- James R Moore
- Jeffrey Lynn Nanamkin
All providers in Nespelem, WA · General Practice Registered Nurse in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.