Provider Demographics
NPI:1821621863
Name:YAKIMA VALLEY FAMILY CLINIC
Entity Type:Organization
Organization Name:YAKIMA VALLEY FAMILY CLINIC
Other - Org Name:YAKIMA VALLEY FAMILY CLINIC, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EZE
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAUBANI
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-367-6066
Mailing Address - Street 1:811 W YAKIMA AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3088
Mailing Address - Country:US
Mailing Address - Phone:509-367-6066
Mailing Address - Fax:509-367-6190
Practice Address - Street 1:811 W YAKIMA AVE STE 104
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3088
Practice Address - Country:US
Practice Address - Phone:509-367-6066
Practice Address - Fax:509-367-6190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty