Basic Information
| Provider Information | |||||||||
| NPI: | 1437197852 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JASZEWSKI | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3838 PACIFIC AVE | ||||||||
| Address2: | |||||||||
| City: | FOREST GROVE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971162224 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3838 PACIFIC AVE | ||||||||
| Address2: | |||||||||
| City: | FOREST GROVE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971162224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9999999999 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 03/21/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1068 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 970024010 | 01 | IA | RAILROAD MEDICARE | OTHER |