Healthcare Provider Details

I. General information

NPI: 1003721697
Provider Name (Legal Business Name): MARK PERPOSE DNP, ARNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15507 85TH AVE E
PUYALLUP WA
98375-8464
US

IV. Provider business mailing address

15507 85TH AVE E
PUYALLUP WA
98375-8464
US

V. Phone/Fax

Practice location:
  • Phone: 808-635-4543
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP.AP.70167510-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: