Organization
FAMILY PRACTICE ASSOCIATES OF WALLA WALLA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DALE T FETROE MD (OWNER)
(509) 522-0606
Entity
Organization
Contact information
Practice address
1017 S 2ND AVE, SUITE 2, WALLA WALLA, WA 99362-4183
(509) 522-0606
Mailing address
PO BOX 1663, WALLA WALLA, WA 99362-0031
(509) 529-1284
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00018950
WA
363L00000X
Nurse Practitioner
AP30002544
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
286465
—
OR
05
—
7079858
—
WA
Enumeration date
01/13/2006
Last updated
10/20/2007
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