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General NPI Number Information
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NPI Number | 1376310979
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Entity Type | Individual
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Provider Name | DAKOTA CHASE ECKLUND
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Gender | Male
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Dates
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Enumeration Date | 12/05/2023
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 510 S WESTVIEW DR
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City | DERBY
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State | KS
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Zip | 67037-1340
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Country | US
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Telephone | 316-869-6961
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Fax |
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Provider Business Mailing Address
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Address Line | 2012 S EDMUNDS ST
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City | SEATTLE
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State | WA
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Zip | 98108-1927
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 23-51030-061
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License Number State | KS
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