Healthcare Provider Details

I. General information

NPI: 1689812570
Provider Name (Legal Business Name): HEIDI RADLINSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EAST 33RD STREET, SUITE 100 FAMILY MEDICINE - OBSTETRICS
VANCOUVER WA
98663
US

IV. Provider business mailing address

1115 SE 164TH AVE DEPT 358
VANCOUVER WA
98683-9324
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-7550
  • Fax: 360-514-7587
Mailing address:
  • Phone: 360-514-7550
  • Fax: 360-514-7587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA106583
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD13304
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60549019
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: