Healthcare Provider Details

I. General information

NPI: 1588546998
Provider Name (Legal Business Name): SWEET LIFE WELLNESS DIRECT PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 INTELCO LOOP SE STE 205
LACEY WA
98503-5117
US

IV. Provider business mailing address

PO BOX 944
EAST OLYMPIA WA
98540-0944
US

V. Phone/Fax

Practice location:
  • Phone: 360-472-4785
  • Fax: 360-299-6116
Mailing address:
  • Phone: 360-472-4785
  • Fax: 360-299-6116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BETHANY SWEET
Title or Position: PHYSICIAN
Credential: MD
Phone: 360-472-4785