Provider Demographics
NPI:1942641584
Name:PNW ENT
Entity Type:Organization
Organization Name:PNW ENT
Other - Org Name:ANDERSON ENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:COPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-828-1346
Mailing Address - Street 1:718 NE 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1970
Mailing Address - Country:US
Mailing Address - Phone:360-828-1346
Mailing Address - Fax:360-828-7627
Practice Address - Street 1:718 NE 87TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1970
Practice Address - Country:US
Practice Address - Phone:360-828-1346
Practice Address - Fax:360-828-7627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034870261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center