Provider Demographics
NPI:1679667026
Name:BUSWELL, KIRSTEN G (DC, ARNP-FNP)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:G
Last Name:BUSWELL
Suffix:
Gender:F
Credentials:DC, ARNP-FNP
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:G
Other - Last Name:IVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE
Mailing Address - Street 2:DEPT. 358
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9324
Mailing Address - Country:US
Mailing Address - Phone:360-414-2000
Mailing Address - Fax:
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2310
Practice Address - Country:US
Practice Address - Phone:360-414-2700
Practice Address - Fax:360-414-2714
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60940473363LF0000X
WACH00034650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2032662Medicaid
WA8943391OtherCRIME VICTIMS
OR271211Medicaid
WA0216726OtherLABOR & IND.
WA0216726OtherLABOR & IND.
WA2032662Medicaid