Provider Demographics
NPI:1821240904
Name:SWEET, BETHANY M (MD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:M
Last Name:SWEET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 TAHOMA BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-7735
Mailing Address - Country:US
Mailing Address - Phone:360-458-7761
Mailing Address - Fax:
Practice Address - Street 1:201 TAHOMA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7735
Practice Address - Country:US
Practice Address - Phone:360-458-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60155686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA273969OtherL&I
WA1821240904Medicaid
WAG8902804Medicare PIN