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General NPI Number Information
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NPI Number | 1124157078
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Entity Type | Individual
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Provider Name | MARY BETHUNE PA
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Gender | Female
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 5216 POINT FOSDICK DR # 102
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City | GIG HARBOR
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State | WA
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Zip | 98335-0037
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Country | US
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Telephone | 253-530-6900
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Fax | 253-530-6901
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Provider Business Mailing Address
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Address Line | 5216 POINT FOSDICK DR # 102
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City | GIG HARBOR
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State | WA
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Zip | 98335-0037
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Country | US
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Telephone | 253-530-6900
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Fax | 253-530-6901
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA10003333
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License Number State | WA
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