Provider Demographics
NPI:1902874415
Name:BATES, MARY ELISABETH (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELISABETH
Last Name:BATES
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:1708 YAKIMA AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5300
Mailing Address - Country:US
Mailing Address - Phone:253-565-5307
Mailing Address - Fax:360-782-3040
Practice Address - Street 1:1628 S MILDRED ST
Practice Address - Street 2:#104
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-1628
Practice Address - Country:US
Practice Address - Phone:253-565-6777
Practice Address - Fax:253-565-8777
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAAP30004223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1021792Medicaid
WA0255610OtherSTATE L&I