Anne Marie Fombu

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP61138151 Issued in WA

Practice address

15015 Main St
Suite #109
Bellevue, WA 98007

Phone

(509) 824-6978

Fax

(509) 824-6961

NPI assigned

Jan 5, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Mary Anne Fombu Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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

• Seattle Ophthalmic Consultants PS

  • Ophthalmology Physician
  • Seattle, WA
  • NPI 1912927468

  Single Specialty

  NPD (past)
• Total Health Medical Institute LLC

  dba La Belle Vie Cosmetic Surgery Center

  • Plastic Surgery Physician
  • Tukwila, WA
  • NPI 1902062706

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740528000000",
    "number": "1245828383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15015 MAIN ST SUITE 109",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "98007",
            "telephone_number": "206-575-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15015 MAIN ST",
            "address_2": "SUITE #109",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "98007",
            "telephone_number": "509-824-6978",
            "fax_number": "509-824-6961"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1215 N Landing Way",
            "address_purpose": "LOCATION",
            "city": "Renton",
            "state": "WA",
            "postal_code": "980575521",
            "country_code": "US",
            "telephone_number": "240-477-2722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOMBU",
        "first_name": "ANNE MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-05",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN60860845",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61138151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY ANNE",
            "last_name": "FOMBU",
            "prefix": "DR.",
            "credential": "NP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Donna J Flynn, LICSW LW00006426 WA
• Marcus Keating Flynn, DDS
• Nicole Michelle Flynn, LICSW
• Ashley Marie-Louise Fogwell, ASHLEY FOGWELL
• Amy Melissa Foley, AU.D.
• Lisa Nicole Fomenoff, D.C.
• Carmen Fong
• Letasha Louise Footman
• Kyle Scott Forbes, DPT
• Mina Fordyce, O.D.

• Family Nurse Practitioner in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.