Basic Information
Provider Information | |||||||||
NPI: | 1205389780 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BURWELL | ||||||||
FirstName: | JOSHUA | ||||||||
MiddleName: | PAUL | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BURWELL | ||||||||
OtherFirstName: | JOSHUA | ||||||||
OtherMiddleName: | PAUL | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PHARMD | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 501 S 5TH AVE | ||||||||
Address2: |   | ||||||||
City: | YAKIMA | ||||||||
State: | WA | ||||||||
PostalCode: | 989023550 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5098531082 | ||||||||
FaxNumber: | 5095735275 | ||||||||
Practice Location | |||||||||
Address1: | 1806 W LINCOLN AVE | ||||||||
Address2: |   | ||||||||
City: | YAKIMA | ||||||||
State: | WA | ||||||||
PostalCode: | 98902 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5094524520 | ||||||||
FaxNumber: | 5094525224 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/01/2016 | ||||||||
LastUpdateDate: | 11/14/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WD0400X | PH60650675 | WA | N |   | Nursing Service Providers | Registered Nurse | Diabetes Educator | 183500000X | PH60650675 | WA | Y |   | Pharmacy Service Providers | Pharmacist |   |
No ID Information.