Provider Demographics
NPI:1033256581
Name:NOPACHAI, S. AMY (MD)
Entity Type:Individual
Prefix:
First Name:S.
Middle Name:AMY
Last Name:NOPACHAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NE 139TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2513
Mailing Address - Country:US
Mailing Address - Phone:360-566-9355
Mailing Address - Fax:360-816-1327
Practice Address - Street 1:900 NE 139TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2513
Practice Address - Country:US
Practice Address - Phone:360-566-9355
Practice Address - Fax:360-816-1327
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040916207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7125131Medicaid
WA8807409Medicare ID - Type Unspecified
WA7125131Medicaid