Healthcare Provider Details

I. General information

NPI: 1972559987
Provider Name (Legal Business Name): MOLLY ELIZABETH MONROE PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S J ST
TACOMA WA
98405-4933
US

IV. Provider business mailing address

505 S 336TH ST SUITE 600
FEDERAL WAY WA
98003-6328
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-4101
  • Fax: 253-426-6250
Mailing address:
  • Phone: 253-838-6180
  • Fax: 253-838-6418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10004851
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberPA10004851
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: