Active NPI
Mary Beth Vanbronkhorst, PA-C
- Physician Assistant
- Everson, WA
National Provider Identifier
1003823147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA10002907
- Practice address
- 407 E Main St
Everson, WA 98247-9525 - Phone
- (360) 966-3441
- Fax
- (360) 966-0969
- NPI assigned
- Aug 2, 2006
- Last updated
- Aug 20, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA10002907 | WA | Primary |
| Medical Physician Assistant | 363AM0700X | PA10002907 | WA |
Addresses
Primary practice location
407 E Main St
Everson, WA 98247-9525
Mailing address
709 W Orchard Dr
Suite #4
Bellingham, WA 98225-1766
Phone (360) 318-8800
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0157259 | Other | WA | L&I PIN |
| 60332U | Other | WA | REGENCE BLUE SHIELD PIN |
| 8324469 | Medicaid | WA | |
| 0308152 | Other | WA | L&I |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA10002907 | WA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376956800000",
"number": "1003823147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "709 W ORCHARD DR",
"address_2": "SUITE #4",
"city": "BELLINGHAM",
"state": "WA",
"postal_code": "982251766",
"telephone_number": "360-318-8800",
"fax_number": "360-318-1085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "407 E MAIN ST",
"city": "EVERSON",
"state": "WA",
"postal_code": "982479525",
"telephone_number": "360-966-3441",
"fax_number": "360-966-0969"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANBRONKHORST",
"first_name": "MARY",
"middle_name": "BETH",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-02",
"last_updated": "2013-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA10002907",
"primary": true
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "WA",
"license": "PA10002907",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I PIN",
"identifier": "0157259",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD PIN",
"identifier": "60332U",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8324469",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I",
"identifier": "0308152",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Everson, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.