Provider Demographics
NPI:1063145522
Name:EUSEBIO, GERALLYNN (PA)
Entity type:Individual
Prefix:
First Name:GERALLYNN
Middle Name:
Last Name:EUSEBIO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 164TH ST SW APT D309
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-7834
Mailing Address - Country:US
Mailing Address - Phone:347-822-3369
Mailing Address - Fax:
Practice Address - Street 1:2510 164TH ST SW APT D309
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-7834
Practice Address - Country:US
Practice Address - Phone:347-822-3369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WA61489439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health