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NPI Code Detail

MEDICARE: ROBERTA A BUUM PA-C

MEDICARE: ROBERTA A BUUM 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
1363A00000XPhysician AssistantPA10003677WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20226463OTHERWAL&I

General Provider Information

NPI Number : 1700830155
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERTA A BUUM PA-C
Provider Business Mailing Address
First Line : 1806 W LINCOLN AVE
Second Line :
City : YAKIMA
State : WA
Zip : 98902-2473
Country : US
Telephone Number : 509-452-4520
Fax Number : 509-452-5224
Provider Business Practice Location Address
First Line : 521 E MOUNTAIN VIEW AVE
Second Line :
City : ELLENSBURG
State : WA
Zip : 98926-3865
Country : US
Telephone Number : 509-962-1414
Fax Number : 509-962-1408
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 01/27/2011

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Directions to “ ROBERTA A BUUM PA-C” Practice Location

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