Basic Information
| Provider Information | |||||||||
| NPI: | 1154520658 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUNSAKER | ||||||||
| FirstName: | WADE | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2801 ST ANTHONY WAY | ||||||||
| Address2: | |||||||||
| City: | PENDLETON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978013800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412788183 | ||||||||
| FaxNumber: | 5412784597 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 ST ANTHONY WAY | ||||||||
| Address2: | |||||||||
| City: | PENDLETON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978013836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419660535 | ||||||||
| FaxNumber: | 5412784597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2007 | ||||||||
| LastUpdateDate: | 02/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 200750078NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 38-1852 | 01 | MEDICARE FQHC | OTHER | 231893 | 05 | OR | MEDICAID | 246615 | 05 | OR | MEDICAID |