Provider Demographics
NPI:1538247994
Name:MARTIN, ALEXA E (PAC)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:E
Last Name:MARTIN
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 1:550 17TH AVE STE 540
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4470
Mailing Address - Country:US
Mailing Address - Phone:206-320-2842
Mailing Address - Fax:206-320-2226
Practice Address - Street 1:550 17TH AVE STE 540
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4470
Practice Address - Country:US
Practice Address - Phone:206-320-2842
Practice Address - Fax:206-320-2226
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003326363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1652OtherINTERNAL ID-MOTOR VEHICLE ID
WA8382608Medicaid
S34319Medicare UPIN
WA8382608Medicaid