Organization
NIKOM WANNARACHUE, M.D., INC. P.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NIKOM WANNARACHUE M.D. (M.D.)
(509) 586-1157
Entity
Organization
Contact information
Practice address
721 S AUBURN ST, KENNEWICK, WA 99336-5665
(509) 586-1157
(509) 582-4189
Mailing address
721 S AUBURN ST, KENNEWICK, WA 99336-5665
(509) 586-1157
(509) 582-4189
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7108723
—
WA
Enumeration date
08/24/2006
Last updated
05/10/2011
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