Individual provider Active NPI

Marlene J Graves, FNP-C

  • Nurse Practitioner
  • Bothell, WA
National Provider Identifier
1114695020
Registry record updated Sep 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP61208623 Issued in WA
Practice address
1909 214TH St SE Ste 300
Bothell, WA 98021-4418
Phone
(206) 505-1040
NPI assigned
Sep 3, 2021
Last updated
Sep 3, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP61208623 WA Primary

Addresses

Primary practice location

1909 214TH St SE Ste 300
Bothell, WA 98021-4418

Mailing address

1200 12TH Ave S
Seattle, WA 98144-2712

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211025001963 WA Practitioner - Nurse Practitioner 0941698963 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Pacmed Clinics CurrentSince Nov 8, 2021 Accepting new patients
Pacmed Clinics Current Accepting new patients
Pacmed Clinics CurrentSince Nov 8, 2021 Accepting new patients

Locations

1909 214th St SE
Ste 300
Bothell, WA 98021
Phone (425) 412-6335

220 15th Ave SE
Puyallup, WA 98372
Phone (253) 435-3400

1200 12th Ave S
Seattle, WA 98144
Phone (206) 326-2400

1101 Madison St
Ste 301
Seattle, WA 98104
Phone (206) 505-1101

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630627200000",
    "number": "1114695020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 12TH AVE S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981442712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1909 214TH ST SE STE 300",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980214418",
            "telephone_number": "206-505-1040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAVES",
        "first_name": "MARLENE",
        "middle_name": "J",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-03",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP61208623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bothell, WA

Sources for this page

Verify at the official NPI Registry.