Healthcare Provider Details

I. General information

NPI: 1144384348
Provider Name (Legal Business Name): MONICA CAULFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503-B HWY 20
WINTHROP WA
98862
US

IV. Provider business mailing address

PO BOX 1197
WINTHROP WA
98862-1197
US

V. Phone/Fax

Practice location:
  • Phone: 509-996-2765
  • Fax: 509-996-4160
Mailing address:
  • Phone: 509-996-2765
  • Fax: 509-996-4160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00004843
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: