Doctor Name: | MR. PETER G. SCOVILLE |
NPI Number: | 1154358240 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | A.R.N.P. |
License Number: | AP30000030 |
Business Practice Address: | 111 Main St Granger, WA - 989329306 |
Business Phone Number: | 5098542772 |
Business Fax Number: | 5098542568 |
Mailing Address: | P.o.box 850, GRANGER |
State: | WA |
Postal Code: | 98932 |
Phone Number: | 5098542772 |
Fax Number: | 5098542568 |
NPI Enumeration Date: | 06/26/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP30000030 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |