Provider Demographics
NPI:1225525090
Name:WASHINGTON STATE UNIVERSITY
Entity Type:Organization
Organization Name:WASHINGTON STATE UNIVERSITY
Other - Org Name:WSU EXTENSION DPP
Other - Org Type:Other Name
Authorized Official - Title/Position:EXTENSION ASSOCIATE PROFESSOR
Authorized Official - Prefix:
Authorized Official - First Name:ZENA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-397-6060
Mailing Address - Street 1:1919 NE 78TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-9752
Mailing Address - Country:US
Mailing Address - Phone:360-402-2744
Mailing Address - Fax:
Practice Address - Street 1:1919 NE 78TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665
Practice Address - Country:US
Practice Address - Phone:360-402-2744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty