| Maple Valley Movement Neurology, Pllc | |
|
22620 Se 216th Pl Ste E Maple Valley WA 98038-6346 | |
| (425) 200-4546 | |
| (425) 523-9167 |
| Full Name | Maple Valley Movement Neurology, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 22620 Se 216th Pl Ste E, Maple Valley, Washington |
| Authorized Official Name and Position | Jennifer Lelia Davis (PHYSICIAN/OWNER) |
| Authorized Official Contact | 4252004546 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maple Valley Movement Neurology, Pllc 22620 Se 216th Pl Ste D Maple Valley WA 98038-6346 Ph: (425) 200-4546 | Maple Valley Movement Neurology, Pllc 22620 Se 216th Pl Ste E Maple Valley WA 98038-6346 Ph: (425) 200-4546 |
| NPI Number | 1265150379 |
|---|---|
| Provider Enumeration Date | 08/16/2022 |
| Last Update Date | 03/17/2023 |
| Certification Date | 03/17/2023 |
| Medicare PECOS PAC ID | 4789051947 |
|---|---|
| Medicare Enrollment ID | O20221101003024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265150379 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Jennifer Lelia Davis |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1831485846 PECOS PAC ID: 7416195193 Enrollment ID: I20160914002148 |
| Provider Name | Natalie Dawn Morgan-romain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285985218 PECOS PAC ID: 2860639655 Enrollment ID: I20180321002555 |
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