Provider Demographics
NPI:1770101636
Name:SHRESTHA, ARSEN (PA-C)
Entity type:Individual
Prefix:
First Name:ARSEN
Middle Name:
Last Name:SHRESTHA
Suffix:
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 1:1350 MARVIN RD NE STE D
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-3877
Mailing Address - Country:US
Mailing Address - Phone:360-493-7712
Mailing Address - Fax:
Practice Address - Street 1:1350 MARVIN RD NE STE D
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-3877
Practice Address - Country:US
Practice Address - Phone:360-493-7712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61080299363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant