Healthcare Provider Details

I. General information

NPI: 1225525090
Provider Name (Legal Business Name): WASHINGTON STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 NE 78TH ST
VANCOUVER WA
98665
US

IV. Provider business mailing address

1919 NE 78TH ST
VANCOUVER WA
98665-9752
US

V. Phone/Fax

Practice location:
  • Phone: 360-402-2744
  • Fax:
Mailing address:
  • Phone: 360-402-2744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: ZENA EDWARDS
Title or Position: EXTENSION ASSOCIATE PROFESSOR
Credential:
Phone: 360-397-6060