Organization
VANCUVER ENT AND ENT OPF NW, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL JEAN EBY (OFFICE MANAGER)
(360) 636-4469
Entity
Organization
Contact information
Practice address
1801 1ST AVE, SUITE 3A, LONGVIEW, WA 98632-3270
(360) 636-4469
Mailing address
1801 1ST AVE, SUITE 3A, LONGVIEW, WA 98632-3270
(360) 636-4469
Taxonomy
Speciality
Code
Description
License number
State
332S00000X
Hearing Aid Equipment
Primary
LD00001333
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9059015
—
WA
Enumeration date
08/05/2007
Last updated
08/14/2007
Update your record
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