Provider Demographics
NPI:1760597496
Name:CASTENSON, DANIEL LEE (PA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:CASTENSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:LEE
Other - Last Name:CASTENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 3002
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-0302
Mailing Address - Country:US
Mailing Address - Phone:360-747-5800
Mailing Address - Fax:
Practice Address - Street 1:1718 E KESSLER BLVD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-1842
Practice Address - Country:US
Practice Address - Phone:360-747-5800
Practice Address - Fax:360-575-3846
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10002004363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0212901OtherLABOR & IND. WA STATE
P00350851OtherRR MEDICARE
WA8320848Medicaid
WA8942418OtherCRIME VICTIMS WA STATE
P13468Medicare UPIN
P00350851OtherRR MEDICARE