Provider Demographics
NPI:1962450064
Name:BATTERBERRY, MAUREEN (PA C)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:BATTERBERRY
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 1:505 S 336TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:34515 9TH AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6761
Practice Address - Country:US
Practice Address - Phone:253-952-7971
Practice Address - Fax:253-944-7922
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003763363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5614BAOtherBLUE SHIELD # VM
WA8325466Medicaid
WA3451MCOtherBSWA
WA0189524OtherLIWA
WA8325466Medicaid
WAG8872688Medicare PIN
WA0189524OtherLIWA
WAG8852072Medicare PIN