Provider Demographics
NPI:1073680146
Name:WAHBA, MARIANNE HANNA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:HANNA
Last Name:WAHBA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MARIANNE
Other - Middle Name:A
Other - Last Name:HANNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:19310 N CREEK PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-8006
Mailing Address - Country:US
Mailing Address - Phone:425-806-5757
Mailing Address - Fax:
Practice Address - Street 1:19310 N CREEK PKWY STE 106
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-8006
Practice Address - Country:US
Practice Address - Phone:425-806-5727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP 2250363A00000X
WAPA 60088178363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant