Organization
PRIVIA MEDICAL GROUP WASHINGTON, PLLC
Active
Other names
Walla Walla Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN J MICHELSON (CEO)
(509) 525-3720
Entity
Organization
Contact information
Practice address
55 W TIETAN ST, WALLA WALLA, WA 99362-4445
(509) 525-3720
(509) 522-1593
Mailing address
55 W TIETAN ST, WALLA WALLA, WA 99362-4445
(509) 525-3720
(509) 522-1593
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP60297383
WA
Other
Enumeration date
06/20/2012
Last updated
10/06/2023
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