Provider Demographics
NPI:1760784797
Name:JERGENS, DANA P (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DANA
Middle Name:P
Last Name:JERGENS
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:805 MADISON ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1172
Mailing Address - Country:US
Mailing Address - Phone:206-264-8100
Mailing Address - Fax:206-264-8689
Practice Address - Street 1:1231 116TH AVE NE
Practice Address - Street 2:SUITE 750
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3804
Practice Address - Country:US
Practice Address - Phone:425-455-3600
Practice Address - Fax:425-455-3220
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2012-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105721363AS0400X
WAPA60285528363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical