Healthcare Provider Details

I. General information

NPI: 1336133644
Provider Name (Legal Business Name): NUCLEAR MEDICINE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 4TH AVE
PASCO WA
99301-5257
US

IV. Provider business mailing address

1222 COUNTRY RIDGE DR
RICHLAND WA
99352-7763
US

V. Phone/Fax

Practice location:
  • Phone: 509-546-2318
  • Fax: 509-546-2317
Mailing address:
  • Phone: 509-627-0953
  • Fax: 509-627-0954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELENA E ICAYAN
Title or Position: OWNER/PHYSICIAN
Credential: MD SC D
Phone: 509-627-0953