Provider Demographics
NPI:1598753675
Name:HALL, JENNIFER HUWALDT (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HUWALDT
Last Name:HALL
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 1:3745 88TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3616
Mailing Address - Country:US
Mailing Address - Phone:361-549-3882
Mailing Address - Fax:
Practice Address - Street 1:8435 SE 68TH ST STE 118
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040
Practice Address - Country:US
Practice Address - Phone:206-232-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INPA17079363A00000X
FLPA9103781363AM0700X
WAPA-60617414363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPA-60617414OtherWASHINGTON LICENSE
CAPA17079OtherLICENSE #
FLPA9103781OtherPA STATE LICENCE
CAPA17079Medicare ID - Type UnspecifiedMEDICARE
FLQ12439Medicare UPIN