Individual
DEJA LINK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4404 80TH ST NE, MARYSVILLE, WA 98270-3427
(360) 659-1231
Mailing address
4404 80TH ST NE, MARYSVILLE, WA 98270-3427
(360) 659-1231
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA.PA.70027026
LICENSE
WA
Enumeration date
08/14/2025
Last updated
01/27/2026
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