Basic Information
| Provider Information | |||||||||
| NPI: | 1710175724 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YAKIMA INDIAN NATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 SIGNAL PEAK ROAD | ||||||||
| Address2: | |||||||||
| City: | WHITE SWAN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098742979 | ||||||||
| FaxNumber: | 5098742113 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 SIGNAL PEAK ROAD | ||||||||
| Address2: | |||||||||
| City: | WHITE SWAN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989520693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098742979 | ||||||||
| FaxNumber: | 5098742113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2007 | ||||||||
| LastUpdateDate: | 10/04/2007 | ||||||||
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| AuthorizedOfficialLastName: | SWAN | ||||||||
| AuthorizedOfficialFirstName: | ELLEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EMS CORDANATOR | ||||||||
| AuthorizedOfficialTelephone: | 5098742979 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | EMT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | PA10002016 | WA | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.