Provider Demographics
NPI:1245218429
Name:STORM, LYNDA JO (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:JO
Last Name:STORM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:
Other - Last Name:GOLDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1374
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004574363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA180728OtherL&I PROVIDER NUMBER
WA178162OtherL&I PROVIDER NUMBER
WA8377517Medicaid
WAG8800650Medicare PIN
WAP00225133Medicare PIN
WA180728OtherL&I PROVIDER NUMBER
WAQ05522Medicare UPIN