Healthcare Provider Details

I. General information

NPI: 1255091302
Provider Name (Legal Business Name): APPLE BROOKE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12704 E NORA AVE STE E
SPOKANE VALLEY WA
99216-1140
US

IV. Provider business mailing address

12704 E NORA AVE STE E
SPOKANE VALLEY WA
99216-1140
US

V. Phone/Fax

Practice location:
  • Phone: 509-242-3039
  • Fax:
Mailing address:
  • Phone: 509-242-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: TAE PEUNEMANY
Title or Position: CEO
Credential:
Phone: 509-279-3850