Healthcare Provider Details

I. General information

NPI: 1396056560
Provider Name (Legal Business Name): ANNE ELIZABETH TOWNSEND L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 ROBERT BUSH
SOUTH BEND WA
98586-0146
US

IV. Provider business mailing address

PO BOX 146 302 ROBERT BUSH
SOUTH BEND WA
98586-0146
US

V. Phone/Fax

Practice location:
  • Phone: 360-875-6063
  • Fax:
Mailing address:
  • Phone: 360-875-6063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN00000468
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: