Healthcare Provider Details

I. General information

NPI: 1962416883
Provider Name (Legal Business Name): NANCY MCFARLANE CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E FOURTH PLAIN BLVD BLDG D-7 SATP
VANCOUVER WA
98661-3753
US

IV. Provider business mailing address

PO BOX 1035 ATTN V3SATP
PORTLAND OR
97207-1035
US

V. Phone/Fax

Practice location:
  • Phone: 360-737-1439
  • Fax: 360-737-1419
Mailing address:
  • Phone: 360-737-1439
  • Fax: 360-737-1419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number29855
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: