Healthcare Provider Details

I. General information

NPI: 1386033603
Provider Name (Legal Business Name): RICHARD ENGEL JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7415 NE 94TH AVE
VANCOUVER WA
98662-3859
US

IV. Provider business mailing address

7415 NE 94TH AVE
VANCOUVER WA
98662-3859
US

V. Phone/Fax

Practice location:
  • Phone: 360-253-2698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN00121986
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: