Healthcare Provider Details

I. General information

NPI: 1598725228
Provider Name (Legal Business Name): DOUGLAS, GRANT, LINCOLN AND OKANOGAN COUNTIES PUBLIC HOSPITAL DIST #6
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 FORTUYN RD
GRAND COULEE WA
99133-8718
US

IV. Provider business mailing address

411 FORTUYN RD
GRAND COULEE WA
99133-8718
US

V. Phone/Fax

Practice location:
  • Phone: 509-633-6388
  • Fax: 509-633-3644
Mailing address:
  • Phone: 509-633-6388
  • Fax: 509-633-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30003947
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberAP30003947
License Number StateWA

VIII. Authorized Official

Name: MS. JULIE D BJORKLUND
Title or Position: HR GENERALIST
Credential:
Phone: 509-633-6388