Mansuru Mustapha, PHYSICIAN ASSISTANT
Individual provider Active NPI Physician Assistant · JBLM, WA
NPI 1013159193 · NPPES record last updated May 30, 2013
Key facts
- NPI
- 1013159193
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 9119 Mil Park Ave
Winder Clinic -Raider Clinic
JBLM, WA 98433-1100 - Phone
- (253) 477-0800
- NPI assigned
- Apr 3, 2009
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
9119 Mil Park Ave
Winder Clinic -Raider Clinic
JBLM, WA 98433-1100
Mailing address
Madigan Army Center 9040 Reid St
Attn: MCHJ-CLQ-C
Tacoma, WA 98431-1100
Phone (253) 968-2252
Other providers in JBLM, WA
- Sammy Martinez
- Jane K McIntosh
- Sandra Christine Milton
- Katrina Salinas Monti
- Munawar P. Mumtaz
- Dennis Abuga Obungu
- Chan M Oh
- Christine Picart
- Andrea Kim Slinkard
- Sherri Ann Smith
All providers in JBLM, WA · Physician Assistant in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.