Provider Demographics
NPI:1154804854
Name:DAMMEN, ALEXANDRA HURTADO (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:HURTADO
Last Name:DAMMEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:HURTADO
Other - Last Name:DAMMEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:9230 SKY ISLAND DR E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-7385
Mailing Address - Country:US
Mailing Address - Phone:253-750-6000
Mailing Address - Fax:253-750-6100
Practice Address - Street 1:9230 SKY ISLAND DR E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-7385
Practice Address - Country:US
Practice Address - Phone:253-750-6000
Practice Address - Fax:253-750-6100
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61001213363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2143588Medicaid
WA591443OtherLABOR & INDUSTRIES