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General NPI Number Information
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NPI Number | 1043769334
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Entity Type | Organization
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Legal Business Name | BLUE PEARL VANCOUVER
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 6607 NE 84TH ST SUITE 109
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City | VANCOUVER
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State | WA
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Zip | 98665-2018
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Country | US
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Telephone | 360-694-3007
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Fax | 360-735-7420
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Provider Business Mailing Address
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Address Line | 6607 NE 84TH ST SUITE 109
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City | VANCOUVER
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State | WA
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Zip | 98665-2018
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Country | US
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Telephone | 360-694-3007
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Fax | 360-735-7420
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Authorized Official
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Title or Position | SR FINANCIAL COORDINATOR/SYSTEMS MN
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Name | LISA HEITING
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Credential |
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Telephone | 360-694-3007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 602889432
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License Number State | WA
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