Provider Demographics
NPI:1184758450
Name:SEDAN, MERLIE (PA)
Entity type:Individual
Prefix:
First Name:MERLIE
Middle Name:
Last Name:SEDAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 NW GILMAN BLVD, PMB 2856
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5327
Mailing Address - Country:US
Mailing Address - Phone:425-557-4227
Mailing Address - Fax:
Practice Address - Street 1:1490 NW GILMAN BLVD
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5327
Practice Address - Country:US
Practice Address - Phone:425-557-4227
Practice Address - Fax:425-557-2858
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005105363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA1856Medicare PIN