Healthcare Provider Details

I. General information

NPI: 1962563718
Provider Name (Legal Business Name): THE WOMENS CLINIC OF VANCOUVER PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 NE 139TH ST SUITE 350
VANCOUVER WA
98686-2309
US

IV. Provider business mailing address

2101 NE 139TH ST SUITE 350
VANCOUVER WA
98686-2309
US

V. Phone/Fax

Practice location:
  • Phone: 360-256-4060
  • Fax: 360-256-0103
Mailing address:
  • Phone: 360-256-4060
  • Fax: 360-256-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHY C VIRTUE
Title or Position: MANAGER
Credential:
Phone: 360-256-4060