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General NPI Number Information
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NPI Number | 1285823005
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Entity Type | Organization
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Legal Business Name | ANKLE & FOOT CLINIC, PS
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 01/17/2008
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Provider Practice Location Address
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Address Line | 416 NE 87TH AVE STE #2
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City | VANCOUVER
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State | WA
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Zip | 98664-1930
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Country | US
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Telephone | 360-256-1777
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Fax | 360-696-4287
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Provider Business Mailing Address
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Address Line | 416 NE 87TH AVE STE #2
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City | VANCOUVER
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State | WA
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Zip | 98664-1930
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Country | US
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Telephone | 360-256-1777
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Fax | 360-696-4287
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DENICE L NOLAN
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Credential |
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Telephone | 360-256-1777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO00000402
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License Number State | WA
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