Detherage, Maria Lynn

Detherage, Maria Lynn is an individual health care provider with primary practice located at 31675 Pacific Hwy S , Federal Way WA 98003-5407. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Detherage, Maria Lynn can be contacted via phone (253) 215-1093.

Contact Information

Primary practice address
31675 Pacific Hwy S Federal Way WA 98003-5407
Phone: (253) 215-1093
Fax: (253) 215-1094
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA60866304 Washington

Profile Details

NPI number 1720219173
LBN Legal business name Detherage, Maria Lynn
Credentials MS, RPAC
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 3rd, 2009
Last updated Nov 12th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720219173 NPPES
Washington MEDICAID 211807

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