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General NPI Number Information
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NPI Number | 1326746884
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Entity Type | Organization
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Legal Business Name | EASTSIDE VACCINATION NETWORK
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Dates
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Enumeration Date | 02/23/2023
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 100 N HOWARD ST STE R
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City | SPOKANE
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State | WA
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Zip | 99201-0508
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Country | US
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Telephone | 206-705-9034
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Fax |
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Provider Business Mailing Address
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Address Line | 736 8TH AVE NE UNIT 206
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City | ISSAQUAH
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State | WA
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Zip | 98029-5452
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DOLMA SHERPA
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Credential |
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Telephone | 206-307-7553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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