Provider Demographics
NPI:1023280682
Name:LIEN, CLANCY
Entity type:Individual
Prefix:
First Name:CLANCY
Middle Name:
Last Name:LIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CLARENCE
Other - Middle Name:OLIVER
Other - Last Name:LIEN
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:8505 S TEXAS RD
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-9340
Mailing Address - Country:US
Mailing Address - Phone:360-293-0896
Mailing Address - Fax:360-293-1555
Practice Address - Street 1:8505 S TEXAS RD
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-9340
Practice Address - Country:US
Practice Address - Phone:360-293-0896
Practice Address - Fax:360-293-1555
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001793363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAR76274Medicare UPIN