Provider Demographics
NPI:1598575169
Name:PACIFIC NORTHWEST ELECTROLOGY LLC
Entity type:Organization
Organization Name:PACIFIC NORTHWEST ELECTROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-734-7764
Mailing Address - Street 1:2612 NE 114TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-4229
Mailing Address - Country:US
Mailing Address - Phone:503-734-7764
Mailing Address - Fax:503-296-2657
Practice Address - Street 1:2612 NE 114TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-4229
Practice Address - Country:US
Practice Address - Phone:503-734-7764
Practice Address - Fax:503-296-2657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-07
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty