Individual
DR. NEENA CHAWLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10004 204TH AVE E, #3400, BONNEY LAKE, WA 98391-6539
(253) 848-5951
(253) 845-7073
Mailing address
3908 10TH ST SE, PUYALLUP, WA 98374-2188
(253) 848-5951
(253) 845-7073
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD00047454
WA
207Q00000X
Family Medicine Physician
Primary
MD00047454
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0262086
STATE L&I
WA
01
—
06415319
ECFMG NUMBER
—
01
—
A97535
PROFESSIONAL LICENSE
CA
01
—
MD00047454
PROFESSIONAL LICENSE
WA
01
—
P00837809
RAILROAD
WA
Enumeration date
04/16/2007
Last updated
03/07/2023
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