Provider Demographics
NPI:1013806272
Name:BASCOM, LILLIAN M (PA-C)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:M
Last Name:BASCOM
Suffix:
Gender:X
Credentials:PA-C
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3040 17TH AVE W APT 433
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3261 W STATE RD
Practice Address - Street 2:
Practice Address - City:SAINT BONAVENTURE
Practice Address - State:NY
Practice Address - Zip Code:14778-9800
Practice Address - Country:US
Practice Address - Phone:503-884-8139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant