Healthcare Provider Details

I. General information

NPI: 1659209633
Provider Name (Legal Business Name): QUINAULT INDIAN NATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 ANDERSON DR STE 203
ABERDEEN WA
98520-1055
US

IV. Provider business mailing address

421 W STATE ST
ABERDEEN WA
98520-6129
US

V. Phone/Fax

Practice location:
  • Phone: 360-533-6063
  • 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 Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

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