Provider Demographics
NPI:1811038508
Name:MACDICKEN, LINDA MAE (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MAE
Last Name:MACDICKEN
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 1:490 YAKIMA RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-8598
Mailing Address - Country:US
Mailing Address - Phone:509-964-2073
Mailing Address - Fax:
Practice Address - Street 1:490 YAKIMA RIVER DR
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-8598
Practice Address - Country:US
Practice Address - Phone:509-964-2073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001551363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical