Provider Demographics
NPI:1093594434
Name:HOMOLKA, SAYDEE (PA-C)
Entity Type:Individual
Prefix:
First Name:SAYDEE
Middle Name:
Last Name:HOMOLKA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10004 204TH AVE E STE 2200
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6537
Mailing Address - Country:US
Mailing Address - Phone:253-447-3300
Mailing Address - Fax:
Practice Address - Street 1:10004 204TH AVE E STE 2200
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-6537
Practice Address - Country:US
Practice Address - Phone:253-447-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61456806363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant