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General NPI Number Information
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NPI Number | 1831347087
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Entity Type | Organization
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Legal Business Name | COMPLEMENTARY INTEGRATED HEALTH CARE,LLC
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Dates
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Enumeration Date | 08/29/2008
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Last Update Date | 10/26/2010
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Provider Practice Location Address
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Address Line | 619 DIAGONAL ST
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City | CLARKSTON
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State | WA
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Zip | 99403-2041
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Country | US
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Telephone | 509-758-9003
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Fax | 509-758-9001
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Provider Business Mailing Address
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Address Line | 619 DIAGONAL ST
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City | CLARKSTON
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State | WA
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Zip | 99403-2041
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Country | US
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Telephone | 509-758-9003
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Fax | 509-758-9001
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Authorized Official
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Title or Position | FNP
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Name | MS. CHARMAINE R ALLEN-JOHNSON
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Credential | ARNP
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Telephone | 509-758-9003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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