Provider Demographics
NPI:1598015919
Name:MUTHEE, PHYLIS (NP)
Entity Type:Individual
Prefix:
First Name:PHYLIS
Middle Name:
Last Name:MUTHEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9802 EVERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-3828
Mailing Address - Country:US
Mailing Address - Phone:425-610-3171
Mailing Address - Fax:866-502-3611
Practice Address - Street 1:9802 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-3828
Practice Address - Country:US
Practice Address - Phone:425-610-3171
Practice Address - Fax:866-502-3611
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2268438363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health