Healthcare Provider Details

I. General information

NPI: 1750046157
Provider Name (Legal Business Name): MARIA JELYN B ENGELHARDT-PARALES NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3716 PACIFIC AVE STE D
TACOMA WA
98418-7836
US

IV. Provider business mailing address

3716 PACIFIC AVE STE D
TACOMA WA
98418-7836
US

V. Phone/Fax

Practice location:
  • Phone: 253-474-7719
  • Fax:
Mailing address:
  • Phone: 253-474-7719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60244982
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number2021085251
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number61165549
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: