Provider Demographics
NPI:1053364935
Name:SEGARS-HUFFSTETLER, AMANDA B (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:B
Last Name:SEGARS-HUFFSTETLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:BROOKE
Other - Last Name:SEGARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 1340
Mailing Address - Street 2:
Mailing Address - City:OKANOGAN
Mailing Address - State:WA
Mailing Address - Zip Code:98840-1340
Mailing Address - Country:US
Mailing Address - Phone:509-422-5700
Mailing Address - Fax:509-422-7680
Practice Address - Street 1:716 FIRST AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:OKANOGAN
Practice Address - State:WA
Practice Address - Zip Code:98840-9679
Practice Address - Country:US
Practice Address - Phone:509-422-5700
Practice Address - Fax:509-422-7680
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60212953363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ60674Medicare UPIN