Healthcare Provider Details

I. General information

NPI: 1629054416
Provider Name (Legal Business Name): MARYELIZABETH HARRIET SCHWIETERT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/24/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER 9040A JACKSON AVE
JOINT BASE LEWIS MCCHORD WA
98431-4880
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CENTER 9040A JACKSON AVE
JOINT BASE LEWIS MCCHORD WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 509-624-1184
  • Fax: 509-625-1449
Mailing address:
  • Phone: 509-850-7026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 10003780
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: