Provider Demographics
NPI:1588546998
Name:SWEET LIFE WELLNESS DIRECT PRIMARY CARE, LLC
Entity type:Organization
Organization Name:SWEET LIFE WELLNESS DIRECT PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-472-4785
Mailing Address - Street 1:PO BOX 944
Mailing Address - Street 2:
Mailing Address - City:EAST OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98540-0944
Mailing Address - Country:US
Mailing Address - Phone:360-472-4785
Mailing Address - Fax:360-299-6116
Practice Address - Street 1:4525 INTELCO LOOP SE STE 205
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5117
Practice Address - Country:US
Practice Address - Phone:360-472-4785
Practice Address - Fax:360-299-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty