Provider Demographics
NPI:1518402346
Name:HUELSKAMP, ALEXANDER M (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:M
Last Name:HUELSKAMP
Suffix:
Gender:M
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 1:607 SE EVERETT MALL WAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3248
Mailing Address - Country:US
Mailing Address - Phone:425-265-7000
Mailing Address - Fax:
Practice Address - Street 1:607 SE EVERETT MALL WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3248
Practice Address - Country:US
Practice Address - Phone:425-265-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant