Individual
DR. PATRICIA M MCILVAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
55 W TIETAN ST, WALLA WALLA, WA 99362-4445
(509) 525-3720
(509) 522-1588
Mailing address
55 W TIETAN ST, WALLA WALLA, WA 99362-4445
(509) 525-3720
(509) 522-1592
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00040784
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
157704
LABOR & INDUSTRIES
WA
05
—
268965
—
OR
05
—
8296022
—
WA
Enumeration date
02/15/2006
Last updated
11/27/2007
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