Provider Demographics
NPI:1104822931
Name:PLANNED PARENTHOOD OF GREATER WASHINGTON & NORTH IDAHO
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD OF GREATER WASHINGTON & NORTH IDAHO
Other - Org Name:PPGWNI KENNEWICK HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-904-7721
Mailing Address - Street 1:1117 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3835
Mailing Address - Country:US
Mailing Address - Phone:866-904-7721
Mailing Address - Fax:509-576-8685
Practice Address - Street 1:7426 W BONNIE PL
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1124
Practice Address - Country:US
Practice Address - Phone:866-904-7721
Practice Address - Fax:509-576-8685
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLANNED PARENTHOOD OF GREATER WASHINGTON & NORTH IDAHO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-27
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA397 020 705207Q00000X
207VG0400X, 261QA0005X, 261QM1300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty