Provider Demographics
NPI:1720150105
Name:DELSECCO, CATHERINE ANNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:ANNE
Last Name:DELSECCO
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 1:8435 SE 68TH ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-5249
Mailing Address - Country:US
Mailing Address - Phone:206-232-7546
Mailing Address - Fax:206-275-0805
Practice Address - Street 1:8435 SE 68TH ST
Practice Address - Street 2:SUITE 118
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-5249
Practice Address - Country:US
Practice Address - Phone:206-232-7546
Practice Address - Fax:206-275-0805
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004561207P00000X
WAPA-10004561363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00274267OtherRAILROAD MEDICARE #
WAUS7872525OtherAETNA SPECIALIST PIN
WA8371676Medicaid
WA0039578OtherLABOR AND INDUSTRIES #
WA3743DEOtherBLUE SHIELD #
WA8371676Medicaid
Q04730Medicare UPIN