MEDICARE: MAKAILA SAMONNE-HUNT PALAZO 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	PA202991	OR

General Provider Information

NPI Number	:	1457940660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKAILA SAMONNE-HUNT PALAZO PA-C

Provider Business Mailing Address
First Line	:	875 OAK ST SE
Second Line	:	STE C3010
City	:	SALEM
State	:	OR
Zip	:	97301-3975
Country	:	US
Telephone Number	:	503-399-7520
Fax Number	:	503-362-7344

Provider Business Practice Location Address
First Line	:	4747 SKYLINE RD S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97306-4200
Country	:	US
Telephone Number	:	503-399-7520
Fax Number	:	503-362-7344

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

Provider Enumeration Date	:	01/12/2021
Last Update Date	:	11/08/2024

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