Provider Demographics
NPI:1568852697
Name:DASH, MARY ELIZABETH (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:DASH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MAY
Other - Middle Name:ELIZABETH
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:13617 56TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-7734
Mailing Address - Country:US
Mailing Address - Phone:775-721-1504
Mailing Address - Fax:360-386-9293
Practice Address - Street 1:13617 56TH AVE NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-7734
Practice Address - Country:US
Practice Address - Phone:775-721-1504
Practice Address - Fax:360-386-9293
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60371254363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health