Provider Demographics
NPI:1467940726
Name:EVERGREEN WOMEN'S HEALTH, PC
Entity Type:Organization
Organization Name:EVERGREEN WOMEN'S HEALTH, PC
Other - Org Name:EVERGREEN INTEGRATIVE GYNECOLOGY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:D'ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-964-3060
Mailing Address - Street 1:1207 WASHINGTON ST UNIT 145
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2997
Mailing Address - Country:US
Mailing Address - Phone:360-964-3060
Mailing Address - Fax:
Practice Address - Street 1:1207 WASHINGTON ST UNIT 145
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2997
Practice Address - Country:US
Practice Address - Phone:360-964-3060
Practice Address - Fax:360-258-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00041848207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1700866084Medicaid