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General NPI Number Information
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NPI Number | 1669283727
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Entity Type | Organization
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Legal Business Name | RIVER VALLEY HEALTH LLC
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 2001 W 5TH ST
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City | GRANDVIEW
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State | WA
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Zip | 98930-9362
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Country | US
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Telephone | 801-913-7271
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Fax |
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Provider Business Mailing Address
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Address Line | 1907 W 2ND ST
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City | GRANDVIEW
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State | WA
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Zip | 98930-1177
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP
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Name | JASEN GIBBONS
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Credential |
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Telephone | 509-531-7267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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