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General NPI Number Information
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NPI Number | 1598575169
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Entity Type | Organization
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Legal Business Name | PACIFIC NORTHWEST ELECTROLOGY LLC
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 11714 NE CRESTWOOD DR STE B
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City | VANCOUVER
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State | WA
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Zip | 98684-5034
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Country | US
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Telephone | 503-734-7764
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Fax |
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Provider Business Mailing Address
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Address Line | 11714 NE CRESTWOOD DR STE B
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City | VANCOUVER
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State | WA
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Zip | 98684-5034
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Country | US
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Telephone | 503-734-7764
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Fax | 503-296-2657
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Authorized Official
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Title or Position | OWNER
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Name | AUDREY JONES
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Credential |
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Telephone | 503-734-7764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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