Healthcare Provider Details

I. General information

NPI: 1740021211
Provider Name (Legal Business Name): LYNDAL DEANNE WILSON-BISHOP PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNDAL D WILSON

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 HOYT AVE
EVERETT WA
98201-4918
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 425-304-1144
  • Fax:
Mailing address:
  • Phone: 206-860-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61602375
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: