Provider Demographics
NPI:1154928653
Name:NORTHWEST NAZARENE UNIVERSITY HEALTH CLINIC
Entity type:Organization
Organization Name:NORTHWEST NAZARENE UNIVERSITY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP STUDENT LIFE
Authorized Official - Prefix:
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-467-8643
Mailing Address - Street 1:623 S UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:623 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5800
Practice Address - Country:US
Practice Address - Phone:208-467-8643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty