Healthcare Provider Details

I. General information

NPI: 1841316023
Provider Name (Legal Business Name): LOWER ELWHA KLALLAM TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243511 HIGHWAY 101
PORT ANGELES WA
98363-9472
US

IV. Provider business mailing address

243511 HIGHWAY 101
PORT ANGELES WA
98363-9472
US

V. Phone/Fax

Practice location:
  • Phone: 360-452-6252
  • Fax: 360-797-1367
Mailing address:
  • Phone: 360-452-6252
  • Fax: 360-797-1367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YOLONDA ZUNIGA
Title or Position: CLINIC MANAGER
Credential:
Phone: 360-452-6252