Facts
- Status
- A
- Credential
- CCHI, DSHS
- Type
- Individual
- Enumeration date
- 2021-07-06
- Last updated
- 2021-07-06
Specialties
Licenses
- License WA
- Number not in the file
- License WA
- 603208957
Location
- Practice location
- 1252 LORENA PL
- City
- WENATCHEE WA
- Postal code
- 988013258
- Phone
- 509-741-0082
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.