Basic Information
| Provider Information | |||||||||
| NPI: | 1073187159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARONG | ||||||||
| FirstName: | BAKARY | ||||||||
| MiddleName: | |||||||||
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| Credential: | DNP ARNP AGACNP-BC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MARONG | ||||||||
| OtherFirstName: | BAKARY | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DNP ARNP AGACNP-BC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12433 ADMIRALTY WAY APT Q403 | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982047570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252687279 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11120 NE 33RD PL STE 202 | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980041444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2068231004 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2021 | ||||||||
| LastUpdateDate: | 05/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | AP61142494 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.