Provider Demographics
NPI:1104037514
Name:MOWER, GINA M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:M
Last Name:MOWER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:MOWER
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:13610 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98168-3404
Mailing Address - Country:US
Mailing Address - Phone:206-988-6836
Mailing Address - Fax:206-274-6835
Practice Address - Street 1:1730 MINOR AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1498
Practice Address - Country:US
Practice Address - Phone:206-267-2100
Practice Address - Fax:206-267-2101
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8866682Medicare PIN