Healthcare Provider Details

I. General information

NPI: 1790963874
Provider Name (Legal Business Name): PROVIDENCE HEALTH CARE DBA MT. CARMEL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 E COLUMBIA AVE
COLVILLE WA
99114-3316
US

IV. Provider business mailing address

910 N WASHINGTON ST SUITE 209
SPOKANE WA
99201-2202
US

V. Phone/Fax

Practice location:
  • Phone: 509-685-2509
  • Fax:
Mailing address:
  • Phone: 509-484-8069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberH-030
License Number StateWA

VIII. Authorized Official

Name: DEBBIE L WICKLUND
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 509-232-1173