| Chelane R Fackenthall, ARNP | |
|
301 W Poplar St, Suite 100, Walla Walla, WA 99362-2858 | |
| (509) 522-5824 | |
| (509) 522-5738 |
| Full Name | Chelane R Fackenthall |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner |
| Experience | 16 Years |
| Location | 301 W Poplar St, Walla Walla, Washington |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699000901 | NPI | - | NPPES |
| 1699000901 | Medicaid | WA | |
| 500616387 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 163W00000X | Registered Nurse | RN00151745 (Washington) | Secondary |
| 363L00000X | Nurse Practitioner | AP60111177 (Washington) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Providence St Mary Medical Center | Walla walla, WA | Hospital |
| Grande Ronde Hospital | La grande, OR | Hospital |
| Dayton General Hospital | Dayton, WA | Hospital |
| Wallowa Memorial Hospital | Enterprise, OR | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Providence Health And Services - Washington | 2860552973 | 223 |
| Entity Name | Providence Health & Services - Washington |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1922259738 PECOS PAC ID: 2860552973 Enrollment ID: O20081223000478 |
| Mailing Address | Practice Location Address |
|---|---|
| Chelane R Fackenthall, ARNP Po Box 34439, Seattle, WA 98124-1439 Ph: () - | Chelane R Fackenthall, ARNP 301 W Poplar St, Suite 100, Walla Walla, WA 99362-2858 Ph: (509) 522-5824 |
Patrick R Smart, ARNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 401 W Poplar St, Sleep Medicine Center, Walla Walla, WA 99362 Phone: 509-522-5946 Fax: 509-522-5527 | |
Delila C Ojeda, ARNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1111 S 2nd Ave, Walla Walla, WA 99362 Phone: 509-522-0100 Fax: 509-527-8010 | |
Hyunjin Eo, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1017 S 2nd Ave Ste 1, Walla Walla, WA 99362 Phone: 509-398-9699 | |
Ms. Leikin Louise Louderback, ARNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 380 Chase Ave, Walla Walla, WA 99362 Phone: 509-897-3333 | |
Emily Grace Castillo, ARNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 55 W Tietan St, Walla Walla, WA 99362 Phone: 509-525-3720 Fax: 509-522-1593 | |
Mary Buriani, ARNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1111 S 2nd Ave, Walla Walla, WA 99362 Phone: 509-527-8151 Fax: 509-527-8010 | |
Susan D Collins, ARNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1111 S 2nd Ave, Walla Walla, WA 99362 Phone: 509-522-0100 Fax: 509-527-8010 |