Healthcare Provider Details

I. General information

NPI: 1780559476
Provider Name (Legal Business Name): QUINAULT INDIAN NATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N PARK ST
ABERDEEN WA
98520-5919
US

IV. Provider business mailing address

421 W STATE ST
ABERDEEN WA
98520-6129
US

V. Phone/Fax

Practice location:
  • Phone: 564-544-1950
  • Fax: 564-544-1938
Mailing address:
  • Phone: 564-544-1950
  • Fax: 564-544-1938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RUBY P SAUNDERS-JEREMIAH
Title or Position: BILLING/CODING SUPERVISOR
Credential:
Phone: 564-544-1950