Healthcare Provider Details

I. General information

NPI: 1457483679
Provider Name (Legal Business Name): TOWN OF EATONVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CENTER STREET W
EATONVILLE WA
98328
US

IV. Provider business mailing address

PO BOX 3510
SILVERDALE WA
98383-3510
US

V. Phone/Fax

Practice location:
  • Phone: 360-832-6931
  • Fax:
Mailing address:
  • Phone: 360-394-7030
  • Fax: 360-394-7097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number27MO5
License Number StateWA

VIII. Authorized Official

Name: SHEILA DUDLEY
Title or Position: ASSISTANT CHIEF
Credential:
Phone: 360-832-6931