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General NPI Number Information
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NPI Number | 1396175139
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Entity Type | Organization
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Legal Business Name | WHITE PINE COMMUNITY TRAINING CENTER INC.
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Dates
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Enumeration Date | 11/14/2013
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 1501 PARK AVE
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City | ELY
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State | NV
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Zip | 89301-2645
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Country | US
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Telephone | 775-289-6713
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 PARK AVE
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City | ELY
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State | NV
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Zip | 89301-2645
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Country | US
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Telephone | 775-289-6713
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. MAURINE W FISHER
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Credential |
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Telephone | 775-289-6713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 9005038557
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License Number State | NV
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