Basic Information
| Provider Information | |||||||||
| NPI: | 1891721361 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DICROCE | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 541 | ||||||||
| Address2: | |||||||||
| City: | TONASKET | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988550541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094861749 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1617 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OROVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988449380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094763631 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2006 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 00044218 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.