Gulstrom, Ty C.

Gulstrom, Ty C. is an individual health care provider with primary practice located at 1400 E. Kincaid Street , Mount Vernon WA 98274-4127. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Gulstrom, Ty C. can be contacted via phone (360) 428-6434.

Contact Information

Primary practice address
1400 E. Kincaid Street Mount Vernon WA 98274-4127
Phone: (360) 428-6434
Fax: (360) 848-4233
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X PA10004348 Washington
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA10004348 Washington
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA10004348 Washington

Profile Details

NPI number 1558306373
LBN Legal business name Gulstrom, Ty C.
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 17th, 2006
Last updated Feb 18th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558306373 NPPES
Washington MEDICAID 8386484
Washington Other 3479GU
Washington Other 605960012
Washington Other 0216864

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