Healthcare Provider Details

I. General information

NPI: 1427459254
Provider Name (Legal Business Name): WHITMAN COLLEGE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MERRIAM ST
WALLA WALLA WA
99362-2030
US

IV. Provider business mailing address

11 MERRIAM ST
WALLA WALLA WA
99362-2030
US

V. Phone/Fax

Practice location:
  • Phone: 509-527-5281
  • Fax: 509-527-4999
Mailing address:
  • Phone: 509-527-5281
  • Fax: 509-527-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA

VIII. Authorized Official

Name: MELISSA MASIAS
Title or Position: OFFICE MANAGER
Credential:
Phone: 509-527-5281