Healthcare Provider Details

I. General information

NPI: 1730986035
Provider Name (Legal Business Name): HRT EVERGREEN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11917 E BROADWAY AVE STE 102
SPOKANE VALLEY WA
99206-6011
US

IV. Provider business mailing address

10501 W GOWAN RD STE 200
LAS VEGAS NV
89129-6602
US

V. Phone/Fax

Practice location:
  • Phone: 602-796-2559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA WILKINSON
Title or Position: BUSINESS OPERATIONS DIRECTOR
Credential:
Phone: 602-796-2559