Healthcare Provider Details

I. General information

NPI: 1447247499
Provider Name (Legal Business Name): CORRINE L BRESKO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORRINE L OENBRING

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16528 DESMET CT
SPOKANE VALLEY WA
99216-3522
US

IV. Provider business mailing address

PO BOX 421
LIBERTY LAKE WA
99019-0421
US

V. Phone/Fax

Practice location:
  • Phone: 509-944-9440
  • Fax:
Mailing address:
  • Phone: 509-944-9440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00044705
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: