Provider Demographics
NPI:1255418810
Name:SURFACE, AMY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:SURFACE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:200 NE MOTHER JOSEPH PL
Mailing Address - Street 2:SUITE 400
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3299
Mailing Address - Country:US
Mailing Address - Phone:360-256-5640
Mailing Address - Fax:360-816-1514
Practice Address - Street 1:200 NE MOTHER JOSEPH PL
Practice Address - Street 2:SUITE 400
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3299
Practice Address - Country:US
Practice Address - Phone:360-256-5640
Practice Address - Fax:360-816-1514
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004375363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB35034Medicare ID - Type Unspecified
WAP80127Medicare UPIN