Individual
MARY BETH VANBRONKHORST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
407 E MAIN ST, EVERSON, WA 98247-9525
(360) 966-3441
(360) 966-0969
Mailing address
709 W ORCHARD DR, SUITE #4, BELLINGHAM, WA 98225-1766
(360) 318-8800
(360) 318-1085
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10002907
WA
363AM0700X
Medical Physician Assistant
PA10002907
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0157259
L&I PIN
WA
01
—
0308152
L&I
WA
01
—
60332U
REGENCE BLUE SHIELD PIN
WA
05
—
8324469
—
WA
Enumeration date
08/02/2006
Last updated
08/20/2013
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