Individual
MARIA LYNN DETHERAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RPAC
Contact information
Practice address
31675 PACIFIC HWY S, FEDERAL WAY, WA 98003-5407
(253) 215-1093
(253) 215-1094
Mailing address
31675 PACIFIC HWY S, FEDERAL WAY, WA 98003-5407
(253) 215-1093
(253) 215-1094
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60866304
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
211807
—
WA
Enumeration date
08/03/2009
Last updated
11/12/2020
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