Provider Demographics
NPI:1558902890
Name:NEWMARKER, EILEEN MARGARET (PA-C)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARGARET
Last Name:NEWMARKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:FAUTEUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:11311 BRIDGEPORT WAY SW STE 309
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3078
Mailing Address - Country:US
Mailing Address - Phone:253-985-2733
Mailing Address - Fax:253-985-2868
Practice Address - Street 1:11311 BRIDGEPORT WAY SW STE 309
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3078
Practice Address - Country:US
Practice Address - Phone:253-985-2733
Practice Address - Fax:253-985-2868
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-006836363A00000X
WAPA61389905363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2259870Medicaid