1073680146 NPI number — MRS. MARIANNE HANNA WAHBA PA-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073680146 NPI number — MRS. MARIANNE HANNA WAHBA PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAHBA
Provider First Name:
MARIANNE
Provider Middle Name:
HANNA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANNA
Provider Other First Name:
MARIANNE
Provider Other Middle Name:
A.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073680146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 SW 7TH ST STE A205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98057-2983
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-222-1275
Provider Business Mailing Address Fax Number:
509-491-3031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 120TH AVE NE STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005-2135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-522-1275
Provider Business Practice Location Address Fax Number:
833-888-7145
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  AP 2250 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA 60088178 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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