Provider Demographics
NPI:1689652802
Name:SIEU, LINDA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:SIEU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:S
Other - Last Name:LAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:500 17TH AVE FL 5
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5711
Practice Address - Country:US
Practice Address - Phone:206-320-2800
Practice Address - Fax:206-320-2827
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003482363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1016315Medicaid
WA1689652802Medicaid
WA185596OtherL&I PROVIDER NUMBER
WA185595OtherL&I PROVIDER NUMBER
WA8801866Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
WA8801864Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER