Individual
JACK EISAMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9631 269TH ST NW, STANWOOD, WA 98292-8071
(360) 629-1600
(360) 629-1644
Mailing address
1400 E KINCAID ST, ATTN: CREDENTIALING, MOUNT VERNON, WA 98274-4127
(360) 428-2500
(360) 428-6485
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA60686334
WA
363AM0700X
Medical Physician Assistant
Primary
PA60686334
WA
Other
Enumeration date
07/13/2016
Last updated
03/30/2021
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