Provider Demographics
NPI:1487822854
Name:WALTMAN, ELIZABETH ANN (PA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:WALTMAN
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 1:3111 WOBURN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6610
Mailing Address - Country:US
Mailing Address - Phone:360-734-1420
Mailing Address - Fax:360-733-1659
Practice Address - Street 1:3111 WOBURN ST STE 201
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6610
Practice Address - Country:US
Practice Address - Phone:360-734-1420
Practice Address - Fax:360-733-1659
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005377363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8946997OtherCRIME VICTIMS
WA0230520OtherLABOR & INDUSTRIES
WA8506750Medicaid
WA8506750Medicaid