Healthcare Provider Details

I. General information

NPI: 1225201791
Provider Name (Legal Business Name): DAVID W AGNOR PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9340 NE 76TH ST
VANCOUVER WA
98662-3721
US

IV. Provider business mailing address

9340 NE 76TH ST
VANCOUVER WA
98662-3721
US

V. Phone/Fax

Practice location:
  • Phone: 360-253-4912
  • Fax: 360-253-5170
Mailing address:
  • Phone: 360-253-4912
  • Fax: 360-253-5170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberPY00001983
License Number StateWA

VIII. Authorized Official

Name: DR. DAVID W AGNOR
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 360-253-4912