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General NPI Number Information
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NPI Number | 1396998001
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Entity Type | Individual
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Provider Name | COLEEN FOREMAN PAC
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Gender | Female
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Dates
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Enumeration Date | 10/24/2008
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Last Update Date | 11/10/2008
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Provider Practice Location Address
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Address Line | 3003 TIETON DR SUITE 200
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City | YAKIMA
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State | WA
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Zip | 98902-3679
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Country | US
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Telephone | 509-454-2229
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Fax | 509-454-7979
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Provider Business Mailing Address
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Address Line | PO BOX 2947
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City | YAKIMA
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State | WA
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Zip | 98907-2947
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Country | US
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Telephone | 509-248-7849
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Fax | 509-248-8291
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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 | PA60051163
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License Number State | WA
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