Provider Demographics
NPI:1992196554
Name:DIMICK, MONICA VIRGINIA (PA-C)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:VIRGINIA
Last Name:DIMICK
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 1:1401 E HOWELL ST
Mailing Address - Street 2:APT 107
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2636
Mailing Address - Country:US
Mailing Address - Phone:907-252-5985
Mailing Address - Fax:
Practice Address - Street 1:1802 S UNION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1947
Practice Address - Country:US
Practice Address - Phone:907-252-5985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant