Healthcare Provider Details

I. General information

NPI: 1912924366
Provider Name (Legal Business Name): MARTHE BUTZEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 E. 44TH STREET
TACOMA WA
98404
US

IV. Provider business mailing address

101 E 26TH ST
TACOMA WA
98421-1108
US

V. Phone/Fax

Practice location:
  • Phone: 253-471-4553
  • Fax: 253-474-5395
Mailing address:
  • Phone: 253-597-4550
  • Fax: 256-372-2154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10004085
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: