Provider Demographics
NPI:1043608243
Name:WASHOE TRIBE OF NEVADA AND CALIFORNIA
Entity Type:Organization
Organization Name:WASHOE TRIBE OF NEVADA AND CALIFORNIA
Other - Org Name:WASHOE TRIBAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-265-4215
Mailing Address - Street 1:1559 WATASHEAMU
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89460-7455
Mailing Address - Country:US
Mailing Address - Phone:775-265-4215
Mailing Address - Fax:775-265-6071
Practice Address - Street 1:1559 WATASHEAMU
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89460-7455
Practice Address - Country:US
Practice Address - Phone:775-265-4215
Practice Address - Fax:775-265-6071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty