Provider Demographics
NPI:1316345218
Name:NAMBO, DANIEL M (RT, HCA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:NAMBO
Suffix:
Gender:M
Credentials:RT, HCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E UNIVERSITY WAY
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-7502
Mailing Address - Country:US
Mailing Address - Phone:509-963-1881
Mailing Address - Fax:509-963-1886
Practice Address - Street 1:400 E UNIVERSITY WAY
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-7502
Practice Address - Country:US
Practice Address - Phone:509-963-1881
Practice Address - Fax:509-963-1886
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPC60347734246RP1900X
WAXT60353146247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy