MEDICARE: SANDI MICHELLE BASTON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-09646	NC
2	363A00000X	Physician Assistant	079375	IA

General Provider Information

NPI Number	:	1801262167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDI MICHELLE BASTON PA-C

Provider Business Mailing Address
First Line	:	200 HAWKINS DR
Second Line	:	DEPARTMENT OF UICMS
City	:	IOWA CITY
State	:	IA
Zip	:	52242-1009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	767 MORMON TREK BLVD
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-1812
Country	:	US
Telephone Number	:	319-384-8822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2015
Last Update Date	:	04/27/2023

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Directions to “ SANDI MICHELLE BASTON PA-C” Practice Location

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