Healthcare Provider Details

I. General information

NPI: 1295891976
Provider Name (Legal Business Name): DANIEL O. MYHRE P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14402 E SPRAGUE AVE
SPOKANE VALLEY WA
99216-2167
US

IV. Provider business mailing address

PO BOX 34584
SEATTLE WA
98124-1584
US

V. Phone/Fax

Practice location:
  • Phone: 509-922-2625
  • Fax:
Mailing address:
  • Phone: 509-241-7349
  • Fax: 509-241-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10000041
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: