Basic Information
| Provider Information | |||||||||
| NPI: | 1396943478 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERNSON | ||||||||
| FirstName: | MARC | ||||||||
| MiddleName: | ISRAEL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10507 156TH ST E | ||||||||
| Address2: | SUITE G112 | ||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983749361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534775053 | ||||||||
| FaxNumber: | 2534775098 | ||||||||
| Practice Location | |||||||||
| Address1: | MADIGAN ARMY MEDICAL HOSPITAL | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984319361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534775053 | ||||||||
| FaxNumber: | 2534775076 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2007 | ||||||||
| LastUpdateDate: | 01/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA 1376 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.