Healthcare Provider Details

I. General information

NPI: 1144694787
Provider Name (Legal Business Name): BROOKSJOHNSONPLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 S. MONROE STREET STE 100
SPOKANE WA
99204
US

IV. Provider business mailing address

1004 S. MONROE STREET STE 100
SPOKANE WA
99204
US

V. Phone/Fax

Practice location:
  • Phone: 509-309-2591
  • Fax: 425-455-5036
Mailing address:
  • Phone: 509-309-2591
  • Fax: 425-455-5036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAREN LEONA HANSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 509-309-2591