=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770495616
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSHUA ROBERTSON PARAMEDIC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2026
-----------------------------------------------------
Last Update Date | 09/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 404 S PARCEL AVE
-----------------------------------------------------
City | YACOLT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98675-0102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-686-3271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 404 S PARCEL AVE
-----------------------------------------------------
City | YACOLT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98675-0102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-686-3271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 146L00000X
-----------------------------------------------------
Taxonomy Name | Paramedic
-----------------------------------------------------
License Number | 3711-6208-5615
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------