Healthcare Provider Details

I. General information

NPI: 1548874837
Provider Name (Legal Business Name): R ELAINE BOGDEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 11/27/2023
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11406 E FAIRVIEW AVE
SPOKANE VALLEY WA
99206-4687
US

IV. Provider business mailing address

11406 E FAIRVIEW AVE
SPOKANE VALLEY WA
99206-4687
US

V. Phone/Fax

Practice location:
  • Phone: 509-640-6804
  • Fax: 509-352-3141
Mailing address:
  • Phone: 509-640-6804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN00075365
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: