Healthcare Provider Details

I. General information

NPI: 1700863958
Provider Name (Legal Business Name): BEV M. ORWIG
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22117 SE 237TH ST
MAPLE VALLEY WA
98038-8533
US

IV. Provider business mailing address

24230 SE 380TH ST
ENUMCLAW WA
98022-8841
US

V. Phone/Fax

Practice location:
  • Phone: 425-432-1234
  • Fax: 425-432-6756
Mailing address:
  • Phone: 360-825-2048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00013042
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: