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General NPI Number Information
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NPI Number | 1043483514
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Entity Type | Organization
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Legal Business Name | DAVID W AGNOR PHD PC
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 9340 NE 76TH ST
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City | VANCOUVER
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State | WA
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Zip | 98662-3721
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Country | US
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Telephone | 360-253-4912
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Fax | 360-253-5170
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Provider Business Mailing Address
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Address Line | 9340 NE 76TH ST
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City | VANCOUVER
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State | WA
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Zip | 98662-3721
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Country | US
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Telephone | 360-253-4912
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Fax | 360-253-5170
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. DAVID W AGNOR
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Credential | PHD
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Telephone | 360-253-4912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | PY00001983
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License Number State | WA
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