Healthcare Provider Details

I. General information

NPI: 1598753675
Provider Name (Legal Business Name): JENNIFER HUWALDT HALL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8435 SE 68TH ST STE 118
MERCER ISLAND WA
98040
US

IV. Provider business mailing address

3745 88TH AVE SE
MERCER ISLAND WA
98040-3616
US

V. Phone/Fax

Practice location:
  • Phone: 206-232-7546
  • Fax:
Mailing address:
  • Phone: 361-549-3882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17079
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9103781
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-60617414
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: