Healthcare Provider Details

I. General information

NPI: 1407353477
Provider Name (Legal Business Name): ANNIE AUGUSTA LENOX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NE 87TH AVE
VANCOUVER WA
98664
US

IV. Provider business mailing address

700 NE 87TH AVE
VANCOUVER WA
98664
US

V. Phone/Fax

Practice location:
  • Phone: 334-234-1830
  • Fax:
Mailing address:
  • Phone: 360-882-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD206121
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61145721
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: