Provider Demographics
NPI:1679910673
Name:PEDERSEN, OREN EDWIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:OREN
Middle Name:EDWIN
Last Name:PEDERSEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:950 E BOGARD RD STE 103
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7184
Mailing Address - Country:US
Mailing Address - Phone:907-352-2880
Mailing Address - Fax:907-352-2885
Practice Address - Street 1:950 E BOGARD RD STE 103
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7184
Practice Address - Country:US
Practice Address - Phone:907-352-2880
Practice Address - Fax:509-385-0670
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA60418997363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant