Provider Demographics
NPI:1780316877
Name:MANDEL, KIRRA (PA-C)
Entity type:Individual
Prefix:
First Name:KIRRA
Middle Name:
Last Name:MANDEL
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 1:29819 5TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-3516
Mailing Address - Country:US
Mailing Address - Phone:801-647-3223
Mailing Address - Fax:
Practice Address - Street 1:15870 1ST AVE S STE 101
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1301
Practice Address - Country:US
Practice Address - Phone:206-242-2501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program