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General NPI Number Information
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NPI Number | 1518056787
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Entity Type | Individual
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Provider Name | MS. PIDGE NECHAK
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 304 N LIESER RD
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City | VANCOUVER
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State | WA
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Zip | 98664-2115
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Country | US
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Telephone | 360-694-7565
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8945
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City | VANCOUVER
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State | WA
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Zip | 98668-8945
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Country | US
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Telephone | 360-750-9780
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | AH10002590
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License Number State | WA
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