Healthcare Provider Details

I. General information

NPI: 1376608307
Provider Name (Legal Business Name): MARY K BASKIN-THOMPSON MSN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 W MARINE VIEW DR STE 6
EVERETT WA
98201-2094
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 425-339-5453
  • Fax: 425-252-4441
Mailing address:
  • Phone: 425-304-4831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61014304
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00002103
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: