Provider Demographics
NPI:1598902884
Name:HUSTEAD, DEBORAH L (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:HUSTEAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 N MISSION ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2007
Mailing Address - Country:US
Mailing Address - Phone:509-662-1955
Mailing Address - Fax:509-662-1855
Practice Address - Street 1:107 W JEWETT BLVD STE 700
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672-8974
Practice Address - Country:US
Practice Address - Phone:509-774-0344
Practice Address - Fax:509-493-4920
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60058335363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant