Healthcare Provider Details

I. General information

NPI: 1902874415
Provider Name (Legal Business Name): MARY ELISABETH BATES A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 S MILDRED ST #104
TACOMA WA
98465-1628
US

IV. Provider business mailing address

1708 YAKIMA AVE STE 205
TACOMA WA
98405-5300
US

V. Phone/Fax

Practice location:
  • Phone: 253-565-6777
  • Fax: 253-565-8777
Mailing address:
  • Phone: 253-565-5307
  • Fax: 360-782-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30004223
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: