Provider Demographics
NPI:1235912544
Name:FJELLSTAD, KARL OLE (PA)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:OLE
Last Name:FJELLSTAD
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:4513 152ND AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-2812
Mailing Address - Country:US
Mailing Address - Phone:253-886-4392
Mailing Address - Fax:
Practice Address - Street 1:1408 3RD ST SE STE 200
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3702
Practice Address - Country:US
Practice Address - Phone:253-268-3345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant