Individual
ANDREW TISTADT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
21810 WILLAMETTE DR STE 200, WEST LINN, OR 97068-3287
(503) 994-4353
(503) 722-5100
Mailing address
21810 WILLAMETTE DR STE 200, WEST LINN, OR 97068-3287
(503) 994-4353
(503) 722-5100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01174
OR
363AM0700X
Medical Physician Assistant
Primary
PA01174
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500622688
—
OR
Enumeration date
11/09/2006
Last updated
03/12/2026
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