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Organization
PINE FAMILY PRACTICE LLC
Active
Organization
PINE FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY PINE PA (OWNER/PROVIDER)
(509) 778-2703
Entity
Organization
Contact information
Practice address
2240 E LINCOLN AVE, SUNNYSIDE, WA 98944-2487
(509) 836-2367
(855) 784-6425
Mailing address
203 SW MALIBU DR, PROSSER, WA 99350-9419
(509) 778-2703
(800) 273-1677
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1004660
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8541989
—
WA
Enumeration date
08/16/2018
Last updated
11/07/2018
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