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General NPI Number Information
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NPI Number | 1558574541
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Entity Type | Organization
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Legal Business Name | CONFEDERATED TRIBES & BANDS OF THE YAKAMA NATION
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 07/14/2009
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Provider Practice Location Address
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Address Line | 80 BIRDSONG LANE
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City | WHITE SWAN
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State | WA
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Zip | 98952
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Country | US
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Telephone | 509-874-2979
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Fax | 509-874-2113
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Provider Business Mailing Address
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Address Line | 80 BIRDSONG LANE
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City | WHITE SWAN
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State | WA
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Zip | 98952
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Country | US
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Telephone | 509-874-2979
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Fax | 509-874-2113
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MS. ELLEN M SWAN
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Credential |
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Telephone | 509-874-2979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 252-11-2016
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License Number State | WA
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