Healthcare Provider Details

I. General information

NPI: 1720313026
Provider Name (Legal Business Name): STUDENT HEALTH OPTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 S 3RD AVE STE B-101
WALLA WALLA WA
99362-3177
US

IV. Provider business mailing address

PO BOX 1075
WALLA WALLA WA
99362-0021
US

V. Phone/Fax

Practice location:
  • Phone: 509-529-5661
  • Fax:
Mailing address:
  • Phone: 509-529-1692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NORMA L HERNANDEZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 509-529-5661