Healthcare Provider Details

I. General information

NPI: 1992230007
Provider Name (Legal Business Name): HUNTER MCCAY ENSRUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 NE 7TH AVE SUITE C-116
VANCOUVER WA
98685-4523
US

IV. Provider business mailing address

9901 NE 7TH AVE STE C116
VANCOUVER WA
98685-4528
US

V. Phone/Fax

Practice location:
  • Phone: 360-571-2432
  • Fax:
Mailing address:
  • Phone: 360-571-2432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: