Healthcare Provider Details

I. General information

NPI: 1407913767
Provider Name (Legal Business Name): RAYMOND H SJERVEN DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 S AUBURN ST
KENNEWICK WA
99336-5661
US

IV. Provider business mailing address

813 S AUBURN ST
KENNEWICK WA
99336-5661
US

V. Phone/Fax

Practice location:
  • Phone: 509-586-8986
  • Fax: 509-586-0314
Mailing address:
  • Phone: 509-586-8986
  • Fax: 509-586-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00000807
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30003043
License Number StateWA

VIII. Authorized Official

Name: DR. RAYMOND HERBERT SJERVEN
Title or Position: OWNER
Credential: D.O.
Phone: 509-586-8986