MEDICARE: MR. DONALD JAMES RAY RN, ADN,BSN,MAED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	RN00118886	WA
2	367500000X	Certified Registered Nurse Anesthetist	AP30005061	WA
3	367500000X	Certified Registered Nurse Anesthetist	200460027CRNA	OR
4	163W00000X	Registered Nurse	RN00118886	WA

General Provider Information

NPI Number	:	1336187806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD JAMES RAY RN, ADN,BSN,MAED

Provider Business Mailing Address
First Line	:	107 S DIVISION ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99202-1510
Country	:	US
Telephone Number	:	509-838-4651
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 N CALISPEL ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-2317
Country	:	US
Telephone Number	:	509-838-4651
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	12/19/2018

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