Provider Demographics
NPI:1316948359
Name:SIMONSON, MARY KRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:KRISTINE
Last Name:SIMONSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4041 RUSTON WAY
Mailing Address - Street 2:#202
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-5378
Mailing Address - Country:US
Mailing Address - Phone:253-759-0288
Mailing Address - Fax:253-761-3288
Practice Address - Street 1:4041 RUSTON WAY
Practice Address - Street 2:#202
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5378
Practice Address - Country:US
Practice Address - Phone:253-759-0288
Practice Address - Fax:253-761-3288
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2012-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA025209 MD000212892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAO6046Medicare UPIN
WA000106207Medicare ID - Type Unspecified