Individual
KACEY HELENA PROVENZANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
780 SWIFT BLVD STE 201, RICHLAND, WA 99352
(509) 942-3288
(509) 942-3167
Mailing address
550 GAGE BLVD STE 101, RICHLAND, WA 99352-9532
(509) 942-3288
(509) 942-3167
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
264720
MA
208800000X
Urology Physician
Primary
MD60964556
WA
Other
Enumeration date
04/03/2013
Last updated
06/23/2021
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