Provider Demographics
NPI:1144207457
Name:BOIRE, MARY CATHERINE (ARNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CATHERINE
Last Name:BOIRE
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 1:1991 S NUGENT RD
Mailing Address - Street 2:
Mailing Address - City:LUMMI ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98262-8642
Mailing Address - Country:US
Mailing Address - Phone:360-758-7115
Mailing Address - Fax:
Practice Address - Street 1:311 GRAND AVE
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4048
Practice Address - Country:US
Practice Address - Phone:360-676-6780
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN 51930363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9604604Medicaid