Provider Demographics
NPI:1669402962
Name:GLISSMEYER, MARGARET LAW (PA-C)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:LAW
Last Name:GLISSMEYER
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 1:1112 6TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4048
Mailing Address - Country:US
Mailing Address - Phone:253-272-8664
Mailing Address - Fax:206-835-7439
Practice Address - Street 1:1112 6TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4048
Practice Address - Country:US
Practice Address - Phone:253-272-8664
Practice Address - Fax:206-835-7439
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMG1163461363A00000X
WAPA60558414363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1055011Medicaid
OR044532Medicaid
OR044532Medicaid