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General NPI Number Information
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NPI Number | 1376845206
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Entity Type | Individual
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Provider Name | MANICHANH JOHN RATTS PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 11/29/2019
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Provider Practice Location Address
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Address Line | 801 E WHEELER RD
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City | MOSES LAKE
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State | WA
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Zip | 98837
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Country | US
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Telephone | 509-765-5606
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Fax | 509-764-3244
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Provider Business Mailing Address
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Address Line | 660 S COOLIDGE ST
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City | MOSES LAKE
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State | WA
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Zip | 98837-1872
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Country | US
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Telephone | 509-793-9715
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Fax | 509-764-3244
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA60197218
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 53707
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60197218
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License Number State | WA
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