Provider Demographics
NPI:1154520658
Name:HUNSAKER, WADE ROBERT (FNP)
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:ROBERT
Last Name:HUNSAKER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 ST ANTHONY WAY
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-3800
Mailing Address - Country:US
Mailing Address - Phone:541-278-8183
Mailing Address - Fax:541-278-4597
Practice Address - Street 1:3001 ST ANTHONY WAY
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3836
Practice Address - Country:US
Practice Address - Phone:541-966-0535
Practice Address - Fax:541-278-4597
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200750078NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
38-1852OtherMEDICARE FQHC
OR231893Medicaid
OR246615Medicaid