Provider Demographics
NPI:1154165249
Name:MUSGRAVE, ANDREW (PA-S2)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MUSGRAVE
Suffix:
Gender:M
Credentials:PA-S2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 SE 71ST PL
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-3697
Mailing Address - Country:US
Mailing Address - Phone:808-295-9821
Mailing Address - Fax:
Practice Address - Street 1:705 SE BASELINE ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4244
Practice Address - Country:US
Practice Address - Phone:503-352-6151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program