Provider Demographics
NPI:1366487803
Name:PAGE, LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:SMELSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:SUITE 901
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-0368
Mailing Address - Country:US
Mailing Address - Phone:360-491-8439
Mailing Address - Fax:360-491-6328
Practice Address - Street 1:3801 5TH ST SE
Practice Address - Street 2:SUITE 110
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2106
Practice Address - Country:US
Practice Address - Phone:253-845-9585
Practice Address - Fax:253-848-1126
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003564363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8379075Medicaid
WAP09013Medicare UPIN