DR. CONNIE LOU LANDRUM (NPI# 1043540651) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043540651 |
| Entity Type | Individual |
| Full Name | DR. CONNIE LOU LANDRUM |
| Credential | M.D. |
| Practice Address |
641 Diamond Vista Dr Port Angeles WA 98363 |
| Mailing Address |
P.o. Box 2986 Port Angeles WA 98362 |
| Practice Telephone | 3604171027 |
| Practice Fax Number | 3604171028 |
| Mailing Telephone | 3604171027 |
| Mailing Fax Number | 3604171028 |
| Enumeration Date | 2010-01-04 |
| Last Update Date | 2010-01-04 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | MD00033643 | WA | Allopathic & Osteopathic Physicians |
| Street Address |
641 DIAMOND VISTA DR |
| City | PORT ANGELES |
| State | WA |
| Zip Code | 98363 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164073185 | Sandra Lier | Technician | 1064 Freshwater Park Rd., Port Angeles, WA 98363 | 2019-09-20 |
| 1053969451 | Kari Ann Walen | Physician Assistant | 4407 Fairmont Ave, Port Angeles, WA 98363 | 2019-08-28 |
| 1407313059 | Christina Chadick | Counselor | 243511 Hwy 101 W., Port Angeles, WA 98363 | 2019-03-01 |
| 1982198214 | Serenity House of Clallam County | Case Management | 2203 W. 18th Street, Port Angeles, WA 98363 | 2018-06-20 |
| 1528564325 | Katelynne Mcdaniels | Behavior Technician | 1915 West 5th St, Port Angeles, WA 98363 | 2018-04-02 |
| 1730574930 | Vladislav Abaturov | Nurse Practitioner | 4407 Fairmont Avenue, Port Angeles, WA 98363 | 2015-04-03 |
| 1710314703 | Allan M Steigerwald | Anesthesiology | 4217 South Bean Road, Port Angeles, WA 98363 | 2013-10-04 |
| 1033431010 | Jean Leslie Kruger | Counselor | 3080 Lower Elwha Road, Port Angeles, WA 98363 | 2010-02-18 |
| 1518297001 | John Robert Zey | General Practice | 601 Diamond Vista Drive, Port Angeles, WA 98363 | 2010-01-05 |
| 1386855492 | Diane Marie Forsmark | Dental Hygienist | 100 Ediz Hook Road, Port Angeles, WA 98363 | 2007-05-24 |
| Find all providers in zip 98363 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518297001 | John Robert Zey | General Practice | 601 Diamond Vista Drive, Port Angeles, WA 98363 | 2010-01-05 |
| 1285013391 | Theodore Edward Harrison | General Practice | 109 N Oak St, Port Angeles, WA 98362-2616 | 2015-05-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063971703 | Source Northwest Integrative Medicine | General Practice | 7206 267th St Nw Ste 102, Stanwood, WA 98292-6269 | 2019-03-12 |
| 1255896601 | Emily Christine Buck | General Practice | 940 Fitzsimmons Dr, Tacoma, WA 98431-0001 | 2019-02-08 |
| 1740755651 | Alyssa Ann Yruegas | General Practice | 2108 W Spruce St, Moses Lake, WA 98837-2853 | 2018-10-06 |
| 1306321237 | Rainier Springs Physician Group, LLC | General Practice | 2805 Ne 129th Street, Vancouver, WA 98686 | 2018-09-26 |
| 1962916437 | Parkview Medical Group Inc | General Practice | 615 S Division St Ste A, Moses Lake, WA 98837-3800 | 2017-11-20 |
| 1790212496 | Thien Thanh Ho | General Practice | 12307 Douglas Rd, Yakima, WA 98908-9129 | 2017-05-12 |
| 1285173625 | Regenerative Medicine Institute, Pllc | General Practice | 731 N Stanley St, Medical Lake, WA 99022-8940 | 2017-02-17 |
| 1457708430 | James Bailey | General Practice | 9040 Jackson Ave Tripler Army Medical Center, Tacoma, WA 98431-5001 | 2016-05-19 |
| 1740635887 | Peter Chulhi Kang | General Practice | 1425 Spring St Apt 802, Seattle, WA 98104-1635 | 2016-04-26 |
| 1831551084 | Anna Hackenmiller | General Practice | 1657 S Nettleton Ln, Spokane, WA 99224-6108 | 2016-03-27 |
| Find all providers with the same taxonomy | ||||
| City | PORT ANGELES |
| Zip Code | 98363 |
Please comment or provide details below to improve the information on DR. CONNIE LOU LANDRUM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.