Healthcare Provider Details

I. General information

NPI: 1164230595
Provider Name (Legal Business Name): MARIANA LEE ENSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIANA LEE SALERNO

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 N LIDGERWOOD ST STE 223
SPOKANE WA
99208-1122
US

IV. Provider business mailing address

611 N IRON BRIDGE WAY
SPOKANE WA
99202-4932
US

V. Phone/Fax

Practice location:
  • Phone: 509-444-8200
  • Fax:
Mailing address:
  • Phone: 509-444-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG61635839
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: