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General NPI Number Information
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NPI Number | 1518277011
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Entity Type | Organization
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Legal Business Name | ASHBROOK MEDICAL FAMILY PRACTICE PS
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 5512 NE 107TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98662-6169
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Country | US
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Telephone | 360-892-2030
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Fax | 360-892-1999
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Provider Business Mailing Address
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Address Line | 5512 NE 107TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98662-6169
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Country | US
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Telephone | 360-892-2030
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Fax | 360-892-1999
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | NATHAN P WILSON
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Credential |
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Telephone | 360-892-2030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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