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General NPI Number Information
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NPI Number | 1790423473
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Entity Type | Individual
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Provider Name | LIFANG NAILL
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Gender | Female
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Dates
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Enumeration Date | 05/23/2022
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 650 N DEVINE RD STE B
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City | VANCOUVER
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State | WA
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Zip | 98661-6979
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Country | US
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Telephone | 360-952-4457
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Fax |
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Provider Business Mailing Address
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Address Line | 4605 ENTERPRISE WAY STE 101
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City | CALDWELL
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State | ID
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Zip | 83605-6889
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Country | US
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Telephone | 208-795-5090
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP61504145
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License Number State | WA
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