Individual
SYDNEY FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1000 S SCHEUBER RD, CENTRALIA, WA 98531-8877
(360) 330-8950
(360) 330-8955
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA61514013
WA
Other
Enumeration date
11/15/2022
Last updated
04/03/2024
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