Kenneth Kelso Wiscomb PA-C

NPI 1053351197 - Family Medicine - 207Q00000X

NPI Details
NPI 1053351197
Gender Male
Enumeration Date 06/07/2006
Last Updated 07/09/2007
Entity Type Individual
Active Over 10 years ago
Practice Location
213 BENDIGO BLVD N
SUITE 1
NORTH BEND WA, 98045-8259, US
Phone (425) 888-5130
Fax (425) 888-5139
Business Location
9450 ETHAN WADE WAY SE
SUITE B
SNOQUALMIE WA, 98065-9520, US
Phone (425) 831-2300
Fax (425) 831-2361
Toxanomy
Taxonomy Code 207Q00000X
License State Washington
License Number PA10000949
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According to our database, Kenneth Kelso Wiscomb PA-C NPI is 1053351197, taxonomy code is 207Q00000X and license number is PA10000949, license state is located at Washington. Kenneth Kelso Wiscomb PA-C physically located at 213 Bendigo Blvd N, North Bend WA, 98045-8259. NPI Number Kenneth Kelso Wiscomb PA-C has the Individual type.

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1053351197 NPI number is provided on an as is basis without warranty of any kind. 1053351197 is maintained by the National Plan & Provider Enumeration System. The contents of Kenneth Kelso Wiscomb PA-C are for informational purposes only.