Provider Demographics
NPI:1932436086
Name:FORSYTH, EMILY SCHROCK (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:SCHROCK
Last Name:FORSYTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16821 SE MCGILLIVRAY BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-0499
Mailing Address - Country:US
Mailing Address - Phone:360-567-1773
Mailing Address - Fax:360-567-1967
Practice Address - Street 1:16821 SE MCGILLIVRAY BLVD
Practice Address - Street 2:STE 110
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-0499
Practice Address - Country:US
Practice Address - Phone:360-567-1773
Practice Address - Fax:360-567-1967
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA 60112462363AM0700X
ORPA161519363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500646638Medicaid