Basic Information
Provider Information
NPI: 1780800177
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAY
FirstName: APRIL
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 577
Address2:  
City: SUNNYSIDE
State: WA
PostalCode: 989440577
CountryCode: US
TelephoneNumber: 5098376911
FaxNumber: 5098376920
Practice Location
Address1: 803 E LINCOLN AVE
Address2:  
City: SUNNYSIDE
State: WA
PostalCode: 989442383
CountryCode: US
TelephoneNumber: 5098376911
FaxNumber: 5098376920
Other Information
ProviderEnumerationDate: 04/17/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XPA10004379WAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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