MEDICARE: LYNN PAGE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA10003564	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366487803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN PAGE PA-C

Provider Business Mailing Address
First Line	:	PO BOX 368
Second Line	:	SUITE 901
City	:	OLYMPIA
State	:	WA
Zip	:	98507-0368
Country	:	US
Telephone Number	:	360-491-8439
Fax Number	:	360-491-6328

Provider Business Practice Location Address
First Line	:	3801 5TH ST SE
Second Line	:	SUITE 110
City	:	PUYALLUP
State	:	WA
Zip	:	98374-2106
Country	:	US
Telephone Number	:	253-845-9585
Fax Number	:	253-848-1126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	08/17/2016

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Directions to “ LYNN PAGE PA-C” Practice Location

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