Provider Demographics
NPI:1730439456
Name:ADRAINCEM, LYNN NGUYEN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:NGUYEN
Last Name:ADRAINCEM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 8TH AVE NE STE 310
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-5436
Mailing Address - Country:US
Mailing Address - Phone:425-454-3938
Mailing Address - Fax:425-392-3561
Practice Address - Street 1:510 8TH AVE NE STE 310
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-5436
Practice Address - Country:US
Practice Address - Phone:425-454-3938
Practice Address - Fax:425-392-3561
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60817908363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2100251Medicaid