Organization
EVERGREEN DERMATOPATHOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY ANNE HAMSTRA MD (PRACTICE OWNER)
(208) 277-9704
Entity
Organization
Contact information
Practice address
2110 N MOLTER RD #112, LIBERTY LAKE, WA 99019
(208) 277-9704
(208) 277-9704
Mailing address
2110 N MOLTER RD #112, LIBERTY LAKE, WA 99019
(208) 277-9704
(208) 277-9704
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
—
—
Other
Enumeration date
04/04/2023
Last updated
04/04/2023
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