Provider Demographics
NPI:1629054416
Name:SCHWIETERT, MARYELIZABETH HARRIET (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARYELIZABETH
Middle Name:HARRIET
Last Name:SCHWIETERT
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 1:104 W 5TH AVE
Mailing Address - Street 2:SUITE 330W
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-4880
Mailing Address - Country:US
Mailing Address - Phone:509-624-1184
Mailing Address - Fax:509-625-1449
Practice Address - Street 1:104 W 5TH AVE
Practice Address - Street 2:SUITE 330W
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-4880
Practice Address - Country:US
Practice Address - Phone:509-624-1184
Practice Address - Fax:509-625-1449
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA 10003780363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8401440Medicaid
WA8401440Medicaid