Healthcare Provider Details

I. General information

NPI: 1760920276
Provider Name (Legal Business Name): RORY CHISHOLM-DRANE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 SWIFT BLVD FL 1
RICHLAND WA
99352-3524
US

IV. Provider business mailing address

550 GAGE BLVD STE 101
RICHLAND WA
99352-9532
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-3060
  • Fax: 509-946-1850
Mailing address:
  • Phone: 971-358-2390
  • Fax: 509-627-2983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60728363
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: