Healthcare Provider Details

I. General information

NPI: 1407711658
Provider Name (Legal Business Name): MR. MASIMBA MUDONHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4712 N VERCLER LN
SPOKANE VALLEY WA
99216-2382
US

IV. Provider business mailing address

4712 N VERCLER LN
SPOKANE VALLEY WA
99216-2382
US

V. Phone/Fax

Practice location:
  • Phone: 509-655-4004
  • Fax: 833-915-4085
Mailing address:
  • Phone: 509-655-4004
  • Fax: 833-915-4085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: