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General NPI Number Information
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NPI Number | 1144795196
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Entity Type | Organization
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Legal Business Name | PERFORMANCE OCCUPATIONAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 10/05/2018
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Last Update Date | 10/05/2018
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Provider Practice Location Address
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Address Line | 11109 NE 14TH ST STE A
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City | VANCOUVER
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State | WA
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Zip | 98684-4366
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Country | US
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Telephone | 360-334-7001
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Fax | 360-450-3357
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Provider Business Mailing Address
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Address Line | 11109 NE 14TH ST STE A
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City | VANCOUVER
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State | WA
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Zip | 98684-4366
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Country | US
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Telephone | 360-334-7001
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Fax | 360-450-3357
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CHARISE BRENES
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Credential |
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Telephone | 360-334-7001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LX0106X
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Taxonomy Name | Occupational Health Nurse Practitioner
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License Number |
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License Number State |
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