Provider Demographics
NPI:1063826329
Name:MB2K, LLC
Entity Type:Organization
Organization Name:MB2K, LLC
Other - Org Name:FAMILYCARE OF KENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ARNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:253-859-2273
Mailing Address - Street 1:10024 SE 240TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-5124
Mailing Address - Country:US
Mailing Address - Phone:253-859-2273
Mailing Address - Fax:253-850-8894
Practice Address - Street 1:10024 SE 240TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-5124
Practice Address - Country:US
Practice Address - Phone:253-859-2273
Practice Address - Fax:253-850-8894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60471340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty