Healthcare Provider Details

I. General information

NPI: 1962718106
Provider Name (Legal Business Name): MRS. BRIANA KAYE HUISMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13214 E MALLON CT
SPOKANE VALLEY WA
99216-1015
US

IV. Provider business mailing address

13214 E MALLON CT
SPOKANE VALLEY WA
99216-1015
US

V. Phone/Fax

Practice location:
  • Phone: 509-850-0527
  • Fax:
Mailing address:
  • Phone: 509-703-3644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW60898346
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMID-83
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: