Healthcare Provider Details

I. General information

NPI: 1033008933
Provider Name (Legal Business Name): OLIVIA JAE MAST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W 5TH AVE
SPOKANE WA
99204-2803
US

IV. Provider business mailing address

2211 E 57TH AVE
SPOKANE WA
99223-6626
US

V. Phone/Fax

Practice location:
  • Phone: 509-603-7101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61472983
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: