Provider Demographics
NPI:1942959622
Name:MARYS ACCESS CLINIC PLLC
Entity type:Organization
Organization Name:MARYS ACCESS CLINIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BULEGA-KASAGGA
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:253-228-8131
Mailing Address - Street 1:2302 S UNION AVE STE C26
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1334
Mailing Address - Country:US
Mailing Address - Phone:425-444-2314
Mailing Address - Fax:253-981-0922
Practice Address - Street 1:2302 S UNION AVE STE C26
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1334
Practice Address - Country:US
Practice Address - Phone:425-444-2314
Practice Address - Fax:253-981-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2221688Medicaid