Provider Demographics
NPI:1366914780
Name:MBUGUA, MARY N
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:N
Last Name:MBUGUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LAKE BELLEVUE DR STE 209
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2417
Mailing Address - Country:US
Mailing Address - Phone:888-715-3513
Mailing Address - Fax:
Practice Address - Street 1:1 LAKE BELLEVUE DR STE 209
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2417
Practice Address - Country:US
Practice Address - Phone:888-715-3513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-24
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61630872363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health