Provider Demographics
NPI:1639362023
Name:MACKLIN, CYNTHIA A (PA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:MACKLIN
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 1:2979 SQUALICUM PKWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1811
Mailing Address - Country:US
Mailing Address - Phone:360-733-7670
Mailing Address - Fax:360-647-1901
Practice Address - Street 1:2979 SQUALICUM PKWY
Practice Address - Street 2:SUITE 203
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1811
Practice Address - Country:US
Practice Address - Phone:360-733-7670
Practice Address - Fax:360-647-1901
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60221857363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB23289OtherPTAN
WAG8903574OtherPTA#
CAOPA191960Medicare UPIN