Provider Demographics
NPI:1942289392
Name:GEFFKEN, MARA LEA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:LEA
Last Name:GEFFKEN
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 1:757 E HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1257
Mailing Address - Country:US
Mailing Address - Phone:509-444-6367
Mailing Address - Fax:509-444-6371
Practice Address - Street 1:757 E HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1257
Practice Address - Country:US
Practice Address - Phone:509-444-6367
Practice Address - Fax:509-444-6371
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004913363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8440760Medicaid
WAMG1315197OtherDEA
WAMG1315197OtherDEA
WA8440760Medicaid
WAQ55519Medicare UPIN