Provider Demographics
NPI:1144842311
Name:KEITH DRAPER, MARY E (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:KEITH DRAPER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:KEITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 80847
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-0847
Mailing Address - Country:US
Mailing Address - Phone:206-793-7391
Mailing Address - Fax:206-708-1823
Practice Address - Street 1:3603 56TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3136
Practice Address - Country:US
Practice Address - Phone:206-793-7391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00138765163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management