Provider Demographics
NPI:1457530495
Name:MAURIN, LINDSAY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:
Last Name:MAURIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4234
Mailing Address - Country:US
Mailing Address - Phone:253-403-2986
Mailing Address - Fax:253-403-1717
Practice Address - Street 1:315 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4234
Practice Address - Country:US
Practice Address - Phone:253-403-2986
Practice Address - Fax:253-403-1717
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005329363A00000X
WAOA60466162363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8499386Medicaid
WA8869187Medicare PIN
WA8869188Medicare PIN