Provider Demographics
NPI:1699838615
Name:WASEM, SCOTT C I (PA-C)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:WASEM
Suffix:I
Gender:M
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:PO BOX 2632
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93279-2632
Mailing Address - Country:US
Mailing Address - Phone:559-733-3346
Mailing Address - Fax:
Practice Address - Street 1:820 S AKERS ST
Practice Address - Street 2:#220
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8346
Practice Address - Country:US
Practice Address - Phone:559-733-3346
Practice Address - Fax:559-733-4475
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14423363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical