Healthcare Provider Details

I. General information

NPI: 1720422512
Provider Name (Legal Business Name): OPTIONS360 WOMEN'S CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 NE 104TH AVE STE 209
VANCOUVER WA
98664-4505
US

IV. Provider business mailing address

PO BOX 61545
VANCOUVER WA
98666-1545
US

V. Phone/Fax

Practice location:
  • Phone: 360-567-0285
  • Fax: 360-567-2232
Mailing address:
  • Phone: 503-816-1882
  • Fax: 360-567-0285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PAMELLA J MARCHAND
Title or Position: CEO
Credential:
Phone: 360-369-4576