Doctor Name: | CHRISTA LOUISE MCVICKER |
NPI Number: | 1336225283 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMP |
License Number: | MA00017671 |
Business Practice Address: | 213 Bendigo Blvd. N. #3 North Bend, WA - 98045 |
Business Phone Number: | 4252410196 |
Business Fax Number: | |
Mailing Address: | Po Box 579, NORTH BEND |
State: | WA |
Postal Code: | 980450579 |
Phone Number: | 4252410196 |
Fax Number: | 4258312244 |
NPI Enumeration Date: | 10/31/2006 |
NPI Last Update Date: | 10/25/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MA00017671 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |