Doctor Name: | DR. CONNIE LOU LANDRUM |
NPI Number: | 1043540651 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | MD00033643 |
Business Practice Address: | 641 Diamond Vista Dr Port Angeles, WA - 98363 |
Business Phone Number: | 3604171027 |
Business Fax Number: | 3604171028 |
Mailing Address: | P.o. Box 2986, PORT ANGELES |
State: | WA |
Postal Code: | 98362 |
Phone Number: | 3604171027 |
Fax Number: | 3604171028 |
NPI Enumeration Date: | 01/04/2010 |
NPI Last Update Date: | 01/04/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | MD00033643 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |