Healthcare Provider Details

I. General information

NPI: 1205151701
Provider Name (Legal Business Name): CODAS PLUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NE TENNEY RD SUITE 110 PMB 433
VANCOUVER WA
98685-2831
US

IV. Provider business mailing address

800 NE TENNEY RD SUITE 110 PMB 433
VANCOUVER WA
98685-2831
US

V. Phone/Fax

Practice location:
  • Phone: 360-576-7777
  • Fax: 360-258-3140
Mailing address:
  • Phone: 360-576-7777
  • Fax: 360-258-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number602387851
License Number StateWA

VIII. Authorized Official

Name: LUANNE LANI CONNER
Title or Position: MANAGER
Credential:
Phone: 360-576-7777