Provider Demographics
NPI:1063077097
Name:RITCHIE, MARINA CHANEL KOVIC (PA)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:CHANEL KOVIC
Last Name:RITCHIE
Suffix:
Gender:
Credentials:PA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE DEPT 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8004
Mailing Address - Country:US
Mailing Address - Phone:360-729-1412
Mailing Address - Fax:360-729-3025
Practice Address - Street 1:2980 SQUALICUM PKWY STE 301
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1880
Practice Address - Country:US
Practice Address - Phone:360-788-6112
Practice Address - Fax:360-788-6114
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA61073921363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant