Healthcare Provider Details

I. General information

NPI: 1316147549
Provider Name (Legal Business Name): VANCOUVER ENT & ENT OF THE NORTHWEST, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 SE 164TH AVE STE 102
VANCOUVER WA
98683-9644
US

IV. Provider business mailing address

1405 SE 164TH AVE STE 102
VANCOUVER WA
98683-9644
US

V. Phone/Fax

Practice location:
  • Phone: 360-256-4425
  • Fax: 360-260-7249
Mailing address:
  • Phone: 360-256-4425
  • Fax: 360-260-7249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: MS. IRENE T HAYWOOD
Title or Position: BILLING OFFICE SUPERVISOR
Credential:
Phone: 360-449-6613