Healthcare Provider Details

I. General information

NPI: 1184568552
Provider Name (Legal Business Name): BREANNA MEKALAH COLVIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BREE COLVIN RN

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 IDAHO ST
LEWISTON ID
83501-1940
US

IV. Provider business mailing address

611 N IRON BRIDGE WAY
SPOKANE WA
99202-4905
US

V. Phone/Fax

Practice location:
  • Phone: 509-444-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number5771245
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: