Healthcare Provider Details

I. General information

NPI: 1750008637
Provider Name (Legal Business Name): MARY E BACHKO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 E 1ST AVE
COLVILLE WA
99114-2802
US

IV. Provider business mailing address

158 E 1ST AVE
COLVILLE WA
99114-2802
US

V. Phone/Fax

Practice location:
  • Phone: 509-684-3584
  • Fax: 509-684-3852
Mailing address:
  • Phone: 509-684-3584
  • Fax: 509-684-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY BACHKO
Title or Position: OWNER
Credential: ARNP/CNM
Phone: 509-684-3584