Provider Demographics
NPI:1679625727
Name:BRINER, MARY MARGARET
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:BRINER
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 1:19980 10TH AVE NE
Mailing Address - Street 2:SUITE 204A
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6321
Mailing Address - Country:US
Mailing Address - Phone:360-434-3067
Mailing Address - Fax:
Practice Address - Street 1:19980 10TH AVE NE
Practice Address - Street 2:SUITE 204 A
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6321
Practice Address - Country:US
Practice Address - Phone:360-697-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist