Provider Demographics
NPI:1619021458
Name:NORBY, MARY JANE (PAC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:NORBY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16259 SYLVESTER RD SW
Mailing Address - Street 2:#401
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3059
Mailing Address - Country:US
Mailing Address - Phone:206-241-9465
Mailing Address - Fax:206-241-9467
Practice Address - Street 1:16259 SYLVESTER RD SW
Practice Address - Street 2:#401
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98166-3059
Practice Address - Country:US
Practice Address - Phone:206-241-9465
Practice Address - Fax:206-241-9467
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001310363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8348658Medicaid
P25237Medicare UPIN
WA8348658Medicaid