| Manette Clinic A Professional Service Corporation | |
|
1100 Wheaton Way Suite F And G Bremerton WA 98310-4459 | |
| (360) 621-2696 | |
| (844) 602-4646 |
| Full Name | Manette Clinic A Professional Service Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 1100 Wheaton Way, Bremerton, Washington |
| Authorized Official Name and Position | Tanya Spoon (OWNER) |
| Authorized Official Contact | 3606212696 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Manette Clinic A Professional Service Corporation Po Box 1266 Bremerton WA 98337-0507 Ph: (360) 621-2696 | Manette Clinic A Professional Service Corporation 1100 Wheaton Way Suite F And G Bremerton WA 98310-4459 Ph: (360) 621-2696 |
| NPI Number | 1013383215 |
|---|---|
| Provider Enumeration Date | 08/11/2015 |
| Last Update Date | 06/16/2021 |
| Medicare PECOS PAC ID | 3779884713 |
|---|---|
| Medicare Enrollment ID | O20151217000562 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013383215 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | AP30007455 (Washington) | Primary |
| Provider Name | Kristen M Childress |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003952870 PECOS PAC ID: 8022024926 Enrollment ID: I20060302000064 |
| Provider Name | Tanya L Spoon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356427918 PECOS PAC ID: 4486758620 Enrollment ID: I20070328000586 |
| Provider Name | William Michael Hall |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134199961 PECOS PAC ID: 3678752342 Enrollment ID: I20110127000024 |
| Provider Name | Deborah C Tillman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518434158 PECOS PAC ID: 5193776680 Enrollment ID: I20190107003044 |
| Provider Name | Katlyn E Sargent Sheets |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952903510 PECOS PAC ID: 4183022908 Enrollment ID: I20211008001887 |
| Provider Name | Courtney M Saint |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528446705 PECOS PAC ID: 5496036063 Enrollment ID: I20220729001678 |
| Provider Name | Chante M Concepcion |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043803000 PECOS PAC ID: 5698116432 Enrollment ID: I20240510002996 |
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