Healthcare Provider Details

I. General information

NPI: 1134552607
Provider Name (Legal Business Name): GENETICS AND FERTILITY CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 NE 134TH ST SUITE 100
VANCOUVER WA
98686-3026
US

IV. Provider business mailing address

2501 NE 134TH ST SUITE 100
VANCOUVER WA
98686-3026
US

V. Phone/Fax

Practice location:
  • Phone: 360-836-4949
  • Fax: 360-836-4938
Mailing address:
  • Phone: 360-836-4949
  • Fax: 360-836-4938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberOP60017367
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOP60017367
License Number StateWA

VIII. Authorized Official

Name: KIRSTEN A SORENSEN
Title or Position: ADMIN
Credential:
Phone: 602-431-1152