Individual
MS. CHARLOTTE KATHERINE MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, M.P.A.S.
Contact information
Practice address
1708 YAKIMA AVE STE 201, TACOMA, WA 98405-5300
(253) 426-4692
(253) 426-6939
Mailing address
1708 YAKIMA AVE STE 201, TACOMA, WA 98405-5300
(253) 426-4692
(253) 426-6939
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110002615
VA
363A00000X
Physician Assistant
52423
CA
363A00000X
Physician Assistant
C0003662
MD
363A00000X
Physician Assistant
PA030515
DC
363A00000X
Physician Assistant
Primary
PA60261126
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003207C95
MEDICARE IDENTIFICATION NUMBER
—
Enumeration date
11/10/2007
Last updated
06/21/2016
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