Healthcare Provider Details

I. General information

NPI: 1285246033
Provider Name (Legal Business Name): ROCHALLE IRENE JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 COMMERCE AVE
LONGVIEW WA
98632-3738
US

IV. Provider business mailing address

128 N VISTA WAY
KELSO WA
98626-3321
US

V. Phone/Fax

Practice location:
  • Phone: 360-560-6464
  • Fax:
Mailing address:
  • Phone: 360-560-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: