Provider Demographics
NPI:1518056787
Name:NECHAK, PIDGE
Entity Type:Individual
Prefix:MS
First Name:PIDGE
Middle Name:
Last Name:NECHAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8945
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98668-8945
Mailing Address - Country:US
Mailing Address - Phone:360-750-9780
Mailing Address - Fax:
Practice Address - Street 1:304 N LIESER RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2115
Practice Address - Country:US
Practice Address - Phone:360-694-7565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAH10002590363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8872979Medicare PIN
WAF13263Medicare UPIN