Healthcare Provider Details

I. General information

NPI: 1669978516
Provider Name (Legal Business Name): TERRA LEE LAWSON-GILBERT CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2018
Last Update Date: 03/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10081 N GOVERNMENT WAY
HAYDEN ID
83835-9677
US

IV. Provider business mailing address

503 N SHAMROCK RD
SPOKANE VALLEY WA
99037-6001
US

V. Phone/Fax

Practice location:
  • Phone: 509-868-9840
  • Fax:
Mailing address:
  • Phone: 509-868-9840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number00000997
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: