Provider Demographics
NPI:1134488323
Name:HUTTON EYER, MARY R (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:HUTTON EYER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 WHEATON WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3319
Mailing Address - Country:US
Mailing Address - Phone:360-377-3923
Mailing Address - Fax:360-373-4988
Practice Address - Street 1:2620 WHEATON WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3335
Practice Address - Country:US
Practice Address - Phone:360-377-3923
Practice Address - Fax:360-373-4988
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60279349363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1134488323Medicaid
G8914411Medicare PIN