Provider Demographics
NPI:1073187159
Name:MARONG, BAKARY (DNP ARNP AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:BAKARY
Middle Name:
Last Name:MARONG
Suffix:
Gender:M
Credentials:DNP ARNP AGACNP-BC
Other - Prefix:MR
Other - First Name:BAKARY
Other - Middle Name:
Other - Last Name:MARONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP ARNP AGACNP-BC
Mailing Address - Street 1:12433 ADMIRALTY WAY APT Q403
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-7570
Mailing Address - Country:US
Mailing Address - Phone:425-268-7279
Mailing Address - Fax:
Practice Address - Street 1:11120 NE 33RD PL STE 202
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1444
Practice Address - Country:US
Practice Address - Phone:206-823-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61142494363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care