Tistadt, Andrew
Tistadt, Andrew is an individual health care provider with primary practice located at 18040 Sw Lower Boones Ferry Rd Ste 304 , Tigard OR 97224-7258. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Tistadt, Andrew can be contacted via phone (503) 216-0700.Contact Information
Primary practice address
18040 Sw Lower Boones Ferry Rd Ste 304
Tigard OR 97224-7258
Phone: (503) 216-0700
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA01174 | Oregon |
Profile Details
| NPI number | 1831269265 |
|---|---|
| LBN Legal business name | Tistadt, Andrew |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 9th, 2006 |
| Last updated | Sep 20th, 2021 - about 4 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1831269265 | NPPES |
| Oregon | MEDICAID | 500622688 |
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