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Organization

NUCLEAR MEDICINE SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. ELENA E ICAYAN MD SC D (OWNER/PHYSICIAN)
(509) 627-0953
Entity
Organization

Contact information

Practice address
520 N 4TH AVE, PASCO, WA 99301-5257
(509) 546-2318
(509) 546-2317
Mailing address
1222 COUNTRY RIDGE DR, RICHLAND, WA 99352-7763
(509) 627-0953
(509) 627-0954

Taxonomy

Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0025988
L & I
05
1409408
WA
05
7056005
WA
Enumeration date
09/01/2005
Last updated
06/16/2008
Update your record

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