MEDICARE: MRS. JENNIFER HUWALDT HALL 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	PA17079	IN
2	363AM0700X	Medical Physician Assistant	PA9103781	FL
3	363AM0700X	Medical Physician Assistant	PA-60617414	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA-60617414	OTHER	WA	WASHINGTON LICENSE
2	PA17079	OTHER	CA	LICENSE #
3	PA9103781	OTHER	FL	PA STATE LICENCE

General Provider Information

NPI Number	:	1598753675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER HUWALDT HALL PA-C

Provider Business Mailing Address
First Line	:	3745 88TH AVE SE
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-3616
Country	:	US
Telephone Number	:	361-549-3882
Fax Number	:

Provider Business Practice Location Address
First Line	:	8435 SE 68TH ST STE 118
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040
Country	:	US
Telephone Number	:	206-232-7546
Fax Number	:

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	10/23/2019

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Directions to “ MRS. JENNIFER HUWALDT HALL PA-C” Practice Location

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