Healthcare Provider Details

I. General information

NPI: 1619811924
Provider Name (Legal Business Name): DECEMBER MARY BRICKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DECEMBER MARY WHETSTONE

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 S J ST
TACOMA WA
98405-4930
US

IV. Provider business mailing address

1617 S J ST
TACOMA WA
98405-4930
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-4297
  • Fax: 253-426-5449
Mailing address:
  • Phone: 253-426-4297
  • Fax: 253-426-5449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License NumberGCL.GT.70123678
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: