Organization
NOOKSACK CENTRAL MANAGEMENT SYSTEM
Active
Other names
NOOKSACK COMMUNITY CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN DUNCAN (NIT CONTROLLER)
(360) 296-2315
Entity
Organization
Contact information
Practice address
6760 MISSION RD, EVERSON, WA 98247-9749
(360) 966-2106
(360) 966-7227
Mailing address
PO BOX 157, DEMING, WA 98244-0157
(360) 966-2106
(360) 966-7227
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0170843
LABOR & INDUSTRIES
WA
05
—
7084346
—
WA
Enumeration date
12/29/2006
Last updated
03/02/2009
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