Provider Demographics
NPI:1306860291
Name:MCELROY, MARIANNE K (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:K
Last Name:MCELROY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-258-3900
Mailing Address - Fax:
Practice Address - Street 1:3927 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4833
Practice Address - Country:US
Practice Address - Phone:425-259-0966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003849363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0970011140OtherRAILROAD MEDICARE
WA67370OtherREGENCE BLUESHIELD
WA1007236Medicaid
WA8321564Medicaid
WA0131539OtherL&I REGULAR
WA423898030OtherGROUP HEALTH COOPERATIVE
WA8925031OtherL&I CRIME VICTIM
WA8321564Medicaid
WAG8913346Medicare PIN
WA67370OtherREGENCE BLUESHIELD