Provider Demographics
NPI:1568659860
Name:RODGERS, MARGARET L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:L
Last Name:RODGERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MARGARET
Other - Middle Name:E
Other - Last Name:LYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:805 MADISON ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1172
Mailing Address - Country:US
Mailing Address - Phone:206-264-8100
Mailing Address - Fax:206-264-8689
Practice Address - Street 1:7308 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8000
Practice Address - Country:US
Practice Address - Phone:253-582-7257
Practice Address - Fax:253-582-1617
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005263363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0226855OtherL & I
WAG8869275OtherMEDICARE PTAN NON-KING CO.