Healthcare Provider Details

I. General information

NPI: 1548410616
Provider Name (Legal Business Name): SUSAN GHYSELS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 S SCHEUBER RD
CENTRALIA WA
98531-9027
US

IV. Provider business mailing address

914 S SCHEUBER RD
CENTRALIA WA
98531-9027
US

V. Phone/Fax

Practice location:
  • Phone: 360-827-8811
  • Fax: 360-330-8969
Mailing address:
  • Phone: 360-827-8811
  • Fax: 360-330-8969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60694076
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: