Healthcare Provider Details

I. General information

NPI: 1912652991
Provider Name (Legal Business Name): TIFFANY NILSON-BARNHART RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 W GARDNER AVE
SPOKANE WA
99201-2059
US

IV. Provider business mailing address

3791 N NIKE CT
POST FALLS ID
83854-9696
US

V. Phone/Fax

Practice location:
  • Phone: 509-503-6010
  • Fax:
Mailing address:
  • Phone: 208-691-5442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number31349
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61155232
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: