MEDICARE: VERDANT HEALTH PLLC

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	363LG0600X	Gerontology Nurse Practitioner

General Provider Information

NPI Number	:	1629835293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERDANT HEALTH PLLC

Provider Business Mailing Address
First Line	:	2438 W CENTENNIAL PL
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-3135
Country	:	US
Telephone Number	:	509-954-2184
Fax Number	:

Provider Business Practice Location Address
First Line	:	2438 W CENTENNIAL PL
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-3135
Country	:	US
Telephone Number	:	509-954-2184
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SELMA GREEN
Credential	:	NP
Telephone Number	:	509-954-2184

Provider Enumeration Date	:	02/29/2024
Last Update Date	:	06/10/2024

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