Provider Demographics
NPI:1255858981
Name:BYLSMA, SAMANTHA NICOLE (PA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:NICOLE
Last Name:BYLSMA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2623
Mailing Address - Country:US
Mailing Address - Phone:360-782-6000
Mailing Address - Fax:253-534-7099
Practice Address - Street 1:2709 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2623
Practice Address - Country:US
Practice Address - Phone:360-782-6000
Practice Address - Fax:253-534-7099
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010897363A00000X
WAPA60793707363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2088772Medicaid