Provider Demographics
NPI:1629055801
Name:WINTER, CAMERON CLARK (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:CAMERON
Middle Name:CLARK
Last Name:WINTER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 19TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4007
Mailing Address - Country:US
Mailing Address - Phone:206-299-1600
Mailing Address - Fax:206-299-1608
Practice Address - Street 1:500 19TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4007
Practice Address - Country:US
Practice Address - Phone:206-299-1600
Practice Address - Fax:206-299-1608
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003743363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant