Provider Demographics
NPI:1629759188
Name:BUENO-MORRISON, HEBIE K
Entity type:Individual
Prefix:
First Name:HEBIE
Middle Name:K
Last Name:BUENO-MORRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7264
Mailing Address - Country:US
Mailing Address - Phone:253-476-6500
Mailing Address - Fax:
Practice Address - Street 1:4301 S PINE ST STE 301
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7206
Practice Address - Country:US
Practice Address - Phone:253-476-6500
Practice Address - Fax:253-476-6547
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60645827163WP0808X
WAAP61565046363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health