Provider Demographics
NPI:1689000937
Name:LINN, SAMANTHA DANIELLE (MMS, PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DANIELLE
Last Name:LINN
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13812 64TH DR SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-5230
Mailing Address - Country:US
Mailing Address - Phone:425-314-4494
Mailing Address - Fax:530-477-9803
Practice Address - Street 1:817 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-1316
Practice Address - Country:US
Practice Address - Phone:509-548-5815
Practice Address - Fax:509-548-1605
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
322D00000X
WAPA.61243362363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0455795OtherDEPARTMENT OF LABOR & INDUSTRIES
WA2202914Medicaid
WA0455796OtherDEPARTMENT OF LABOR & INDUSTRIES