Provider Demographics
NPI:1467859827
Name:KANDORA, JILL ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ROSE
Last Name:KANDORA
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 1:11032 GREENWOOD AVE N UNIT C
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-7633
Mailing Address - Country:US
Mailing Address - Phone:516-754-5794
Mailing Address - Fax:
Practice Address - Street 1:20120 BALLINGER WAY NE STE A-01
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-1117
Practice Address - Country:US
Practice Address - Phone:206-365-9000
Practice Address - Fax:206-365-9001
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA 60513573363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant