Provider Demographics
NPI:1801982582
Name:BUSER, ANDREA F (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:F
Last Name:BUSER
Suffix:
Gender:F
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 11009
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-1009
Mailing Address - Country:US
Mailing Address - Phone:360-352-2037
Mailing Address - Fax:360-352-0637
Practice Address - Street 1:107 N 8TH ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2513
Practice Address - Country:US
Practice Address - Phone:360-426-9717
Practice Address - Fax:360-426-9750
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10000465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0132053OtherL&I
WACJ4651OtherMEDICARE RR
WA8473084Medicaid
WA0132053OtherL&I
WA8473084Medicaid