Provider Demographics
NPI:1770575722
Name:CHAPLIN, DEBORAH (PAC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:CHAPLIN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17722 TALBOT RD S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5744
Mailing Address - Country:US
Mailing Address - Phone:425-228-0722
Mailing Address - Fax:425-271-2566
Practice Address - Street 1:17722 TALBOT RD S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5744
Practice Address - Country:US
Practice Address - Phone:425-228-0722
Practice Address - Fax:425-271-2566
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004232363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAUS7305700OtherAETNA PCP PIN #
WA8377145Medicaid
WA3672CHOtherBLUE SHIELD #
AB25841Medicare ID - Type Unspecified
WA8868558Medicare PIN
WA3672CHOtherBLUE SHIELD #
WA8377145Medicaid