Provider Demographics
NPI:1780757153
Name:SLUSHER, JEANNE S (PA-C)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:S
Last Name:SLUSHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:
Other - Last Name:DEDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MPH, MPAS
Mailing Address - Street 1:MADIGAN ARMY MEDICAL CENTER
Mailing Address - Street 2:9040 JACKSON AVE
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98433-1100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-5000
Practice Address - Country:US
Practice Address - Phone:253-968-4968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001001214363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2759110OtherMEDICARE PTAN
NC2759110AOtherMEDICARE PTAN