Provider Demographics
NPI:1639646128
Name:HALELA, SAMANTHA RACHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RACHELLE
Last Name:HALELA
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 1:1135 116TH AVE NE STE 305
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4623
Mailing Address - Country:US
Mailing Address - Phone:425-453-1772
Mailing Address - Fax:425-453-0603
Practice Address - Street 1:4011 TALBOT RD S STE 420
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5791
Practice Address - Country:US
Practice Address - Phone:425-690-3456
Practice Address - Fax:425-690-9456
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60908087363A00000X
WAPA60908087363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2155852Medicaid