Individual
CHELANE R FACKENTHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
301 W POPLAR ST, SUITE 100, WALLA WALLA, WA 99362-2858
(509) 522-5824
(509) 522-5738
Mailing address
PO BOX 34439, SEATTLE, WA 98124-1439
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN00151745
WA
363L00000X
Nurse Practitioner
Primary
AP60111177
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699000901
—
WA
05
—
500616387
—
OR
Enumeration date
10/05/2009
Last updated
05/18/2021
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