Healthcare Provider Details

I. General information

NPI: 1275093999
Provider Name (Legal Business Name): DELANIE URRUTIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

IV. Provider business mailing address

101 W 8TH AVE
SPOKANE WA
99204-2307
US

V. Phone/Fax

Practice location:
  • Phone: 208-765-8585
  • Fax:
Mailing address:
  • Phone: 509-474-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP61158265
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number57642
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: