Provider Demographics
NPI:1396933982
Name:MILLS, LINDSEY DEANNE (PA)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:DEANNE
Last Name:MILLS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:DEANNE
Other - Last Name:MEADOWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5608 17TH AVE NW STE 1704
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-5232
Mailing Address - Country:US
Mailing Address - Phone:360-362-0336
Mailing Address - Fax:866-336-7343
Practice Address - Street 1:5608 17TH AVE NW STE 1704
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5232
Practice Address - Country:US
Practice Address - Phone:360-362-0336
Practice Address - Fax:866-336-7343
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60622721363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002620Medicaid
WVPR9362411Medicare PIN