JACK EISAMAN (NPI# 1356794432) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356794432 |
| Entity Type | Individual |
| Full Name | JACK EISAMAN |
| Other Name | JACKSON EISAMAN |
| Credential | PA-C |
| Practice Address |
9631 269th St Nw Stanwood WA 98292-8071 |
| Mailing Address |
1400 E Kincaid St Attn: Credentialing Mount Vernon WA 98274-4127 |
| Practice Telephone | 3606291600 |
| Practice Fax Number | 3606291644 |
| Mailing Telephone | 3604282500 |
| Mailing Fax Number | 3604286485 |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2016-11-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | PA60686334 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA60686334 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
9631 269TH ST NW |
| City | STANWOOD |
| State | WA |
| Zip Code | 98292-8071 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598751588 | Patrick A Clark | Family Medicine | 9631 269th St Nw, Stanwood, WA 98292-8071 | 2005-09-23 |
| 1790254100 | Zackary Kane Hanson | Physician Assistant | 9631 269th St Nw, Stanwood, WA 98292-8071 | 2018-11-14 |
| 1770937831 | Oksana S Miller | Family Medicine | 9631 269th St Nw, Stanwood, WA 98292-8071 | 2016-04-14 |
| 1952649055 | Arnold Andre Ronning | Pediatrics | 9631 269th St Nw, Stanwood, WA 98292-8071 | 2013-01-23 |
| 1689910408 | Safe Harbor Free Clinic | Clinic/Center | 9631 269th St Nw, Stanwood, WA 98292-8071 | 2012-12-26 |
| 1639432537 | David M. Escobar | Neuromusculoskeletal Medicine & OMM | 9631 269th St Nw, Stanwood, WA 98292 | 2012-06-17 |
| 1750607032 | Safe Harbor Free Clinic | Voluntary or Charitable | 9631 269th St Nw, Stanwood, WA 98292-8071 | 2010-04-13 |
| 1013122779 | Skagit Valley Medical Center | General Practice | 9631 269th St Nw, Stanwood, WA 98292-8071 | 2007-05-14 |
| 1598970212 | Skagit Valley Medical Center, Inc Ps | General Practice | 9631 269th St Nw, Stanwood, WA 98292-8071 | 2007-05-14 |
| 1467441063 | Carol L Hoeksema | Family Medicine | 9631 269th St Nw, Stanwood, WA 98292-8071 | 2005-10-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265952303 | Sabrina Ashley Barrera | Massage Therapist | 7202 267th St Nw Ste 104b, Stanwood, WA 98292 | 2017-06-20 |
| 1104355155 | Richard Lee Harman | Ophthalmology | 10101 270th St. Nw, #195, Stanwood, WA 98292 | 2017-06-05 |
| 1629472428 | Melisa Donnelly | Speech-Language Pathologist | 9901 272nd Place Nw, Stanwood, WA 98292 | 2014-10-22 |
| 1790194512 | Rachelle Eve Hamaker | Massage Therapist | 9806 270th St. N.w. #c, Stanwood, WA 98292 | 2014-08-06 |
| 1255693909 | Gary Rhett Andelin | Emergency Medicine | 9631 - 269th Street Nw, Stanwood, WA 98292 | 2012-06-08 |
| 1285927160 | Rachael Anne Davis | Massage Therapist | 9009 271 Street Nw, Stanwood, WA 98292 | 2011-05-25 |
| 1295024610 | Linda K Ricks | Massage Therapist | 2522 256th St Nw, Stanwood, WA 98292 | 2011-04-06 |
| 1760789747 | Suzann Lorene Oakes | Physical Therapist | 20420 Marine Dr., Stanwood, WA 98292 | 2011-02-28 |
| 1588965735 | Elizabeth Ann Burr | Counselor | 23306 Marine Dr., Stanwood, WA 98292 | 2010-11-04 |
| 1780984898 | Jennifer Paige Hoorn | Physical Therapy Assistant | 20420 Marine Drive, Stanwood, WA 98292 | 2010-10-25 |
| Find all providers in zip 98292 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790254100 | Zackary Kane Hanson | Physician Assistant | 9631 269th St Nw, Stanwood, WA 98292-8071 | 2018-11-14 |
| 1982848693 | Kevin M Darland | Physician Assistant | 7205 265th St Nw, Stanwood, WA 98292-6221 | 2009-04-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033735618 | Gavin Guard | Physician Assistant | 818 Mullis St Ste 6, Friday Harbor, WA 98250-7986 | 2020-06-19 |
| 1578110862 | Kaitlin E. Brotman | Physician Assistant | 315 Holton Ave Ste 100, Yakima, WA 98902-3245 | 2019-08-21 |
| 1700345196 | Kara Lynn Kime | Physician Assistant | 1200 Cooper Point Rd Sw Ste 100, Olympia, WA 98502-1172 | 2019-03-15 |
| 1679056824 | Katharine Loco-marshall | Physician Assistant | 4816 She-nah-num Drive, Olympia, WA 98513 | 2018-09-13 |
| 1841791274 | Sjs, Pllc | Physician Assistant | 900 Ocean Beach Hwy Ste B, Longview, WA 98632-4013 | 2018-02-21 |
| 1063928448 | Heidi April | Physician Assistant | 1410 N Pittsburgh St, Building A, Kennewick, WA 99336-8211 | 2017-12-20 |
| 1194251983 | Christopher Joseph Stanley | Physician Assistant | 1010 Ne Lilac St Apt 301, Issaquah, WA 98029-7878 | 2017-05-11 |
| 1366993362 | Vanessa Julie Iglesias Mehta | Physician Assistant | 5128 Yelm Hwy Se, Suite E, Lacey, WA 98503 | 2016-10-14 |
| 1801344601 | Jessica Ann Pettitt | Physician Assistant | 21200 Ne 190th Ct, Battle Ground, WA 98604-9636 | 2016-09-21 |
| 1407300098 | Joshua David Evans | Physician Assistant | 9040 Jackson Ave Mchj Clq C, Tacoma, WA 98431-1100 | 2016-08-11 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.