Provider Demographics
NPI:1386790384
Name:WITCHER, ALBERTA F (PAC)
Entity type:Individual
Prefix:
First Name:ALBERTA
Middle Name:F
Last Name:WITCHER
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 1:1100 OLIVE WAY MSC M4-PA
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1873
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:380 WINSLOW WAY E
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2424
Practice Address - Country:US
Practice Address - Phone:206-842-5631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10000616363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAUS2252350OtherUS SPECIALIST PIN
WAWI8508OtherBLUE SHIELD #
WA0039581OtherLABOR AND INDUSTRIES #
WA970020486OtherRAILROAD MEDICARE
WAUS0818501OtherAETNA PCP PIN
WA8329252Medicaid
WA8895410Medicare PIN
WAWI8508OtherBLUE SHIELD #
WA970020486OtherRAILROAD MEDICARE
WA8329252Medicaid