Provider Demographics
NPI:1265416135
Name:BACHKO, MARY ELIZABETH (ADVANCE PRACTICE REG)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:BACHKO
Suffix:
Gender:F
Credentials:ADVANCE PRACTICE REG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 N BROOKS RD
Mailing Address - Street 2:
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-8663
Mailing Address - Country:US
Mailing Address - Phone:509-342-7411
Mailing Address - Fax:
Practice Address - Street 1:9803 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-3645
Practice Address - Country:US
Practice Address - Phone:509-342-7411
Practice Address - Fax:509-342-7413
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6442363LF0000X
WAAP30003374363L00000X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9617069OtherDSHS #
WA9617069OtherDSHS #
WAS70706Medicare UPIN