Healthcare Provider Details

I. General information

NPI: 1902770837
Provider Name (Legal Business Name): MARYGRACE KATHLEEN DENNIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

212 E WEILE AVE APT 2
SPOKANE WA
99208-5443
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-3342
  • Fax:
Mailing address:
  • Phone: 509-301-6405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number61456097
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: