# PINE FAMILY PRACTICE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770063968
- **Authorized official:** MS. MARY PINE PA (OWNER/PROVIDER)
- **Authorized official phone:** (509) 778-2703

## Contact information

- **Practice address:** 2240 E LINCOLN AVE, SUNNYSIDE, WA 98944-2487
- **Practice address phone:** (509) 836-2367
- **Practice address fax:** (855) 784-6425
- **Mailing address:** 203 SW MALIBU DR, PROSSER, WA 99350-9419
- **Mailing address phone:** (509) 778-2703
- **Mailing address fax:** (800) 273-1677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 1004660 | WA | Yes |

## Other

- **Enumeration date:** 08/16/2018
- **Last updated:** 11/07/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 8541989 | — | WA |