Individual
MR. ETHAN D WASHBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1550 S PIONEER WAY, MOSES LAKE, WA 98837-4613
(509) 793-9770
Mailing address
660 S COOLIDGE ST, MOSES LAKE, WA 98837-1872
(509) 793-9715
(509) 764-3244
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60120190
WA
363AM0700X
Medical Physician Assistant
PA60120190
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2004464
—
WA
Enumeration date
10/28/2009
Last updated
11/21/2019
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