Healthcare Provider Details

I. General information

NPI: 1255304499
Provider Name (Legal Business Name): AURORA HORSTKAMP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 06/17/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NE 1125 WASHINGTON ST WASHINGTON STATE UNIVERSITY
PULLMAN WA
99164-0001
US

IV. Provider business mailing address

PO BOX 367
LAPWAI ID
83540-0367
US

V. Phone/Fax

Practice location:
  • Phone: 509-335-3575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00033290
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-16585
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: