Basic Information
| Provider Information | |||||||||
| NPI: | 1053699645 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FANCHER | ||||||||
| FirstName: | WHITNEY | ||||||||
| MiddleName: | BLAIRE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1793 13TH ST SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973022541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033628385 | ||||||||
| FaxNumber: | 5033628435 | ||||||||
| Practice Location | |||||||||
| Address1: | 1106 DOUGLAS ST STE F | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986322429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606364500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2011 | ||||||||
| LastUpdateDate: | 02/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 125059648 | IL | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | MD60644753 | WA | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | MD177022 | OR | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 63662 | WI | N | Allopathic & Osteopathic Physicians | Dermatology | 207ND0101X | MD60644753 | WA | N | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery | 207ND0101X | 63662 | WI | N | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery | 207ND0101X | MD177022 | OR | Y | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery |
No ID Information.