1154303428 NPI number — DR. EVANGELINE V DACANAY MD

Table of content: DR. EVANGELINE V DACANAY MD (NPI 1154303428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154303428 NPI number — DR. EVANGELINE V DACANAY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DACANAY
Provider First Name:
EVANGELINE
Provider Middle Name:
V
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154303428
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 S DIVISION ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99202-1510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-838-4651
Provider Business Mailing Address Fax Number:
509-363-2762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 WEST MAPLE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDICAL LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99022-0800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-299-3121
Provider Business Practice Location Address Fax Number:
509-299-7015
Provider Enumeration Date:
11/14/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  MD00028755 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1020843 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8131823 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".