Healthcare Provider Details

I. General information

NPI: 1891874848
Provider Name (Legal Business Name): JANET G WARDLE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W 2ND AVE
SPOKANE WA
99201-4503
US

IV. Provider business mailing address

3919 N MAPLE ST
SPOKANE WA
99205-1349
US

V. Phone/Fax

Practice location:
  • Phone: 509-444-8888
  • Fax: 509-444-7806
Mailing address:
  • Phone: 509-444-8888
  • Fax: 509-444-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH00006552
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: