Healthcare Provider Details

I. General information

NPI: 1063334845
Provider Name (Legal Business Name): GHIRMAY MIHRETEAB KIDANE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 E UPRIVER DR
SPOKANE WA
99207-5573
US

IV. Provider business mailing address

2735 E UPRIVER DR
SPOKANE WA
99207-5573
US

V. Phone/Fax

Practice location:
  • Phone: 509-808-2560
  • Fax:
Mailing address:
  • Phone: 509-808-2560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.RN.61153494
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: