Provider Demographics
NPI:1366495418
Name:BINGHAM, WENDY S (PA-C)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 134TH ST SW
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-5322
Mailing Address - Country:US
Mailing Address - Phone:425-297-6200
Mailing Address - Fax:425-297-6250
Practice Address - Street 1:728 134TH ST SW
Practice Address - Street 2:SUITE 120
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-5322
Practice Address - Country:US
Practice Address - Phone:425-297-6200
Practice Address - Fax:425-297-6250
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004147363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA173000OtherL&I NUMBER
VAP58832Medicare UPIN