Healthcare Provider Details

I. General information

NPI: 1740114552
Provider Name (Legal Business Name): MOSES MIKHEYEV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE
SPOKANE WA
99204-2364
US

IV. Provider business mailing address

4715 N WOODLAWN LN
SPOKANE VALLEY WA
99216-2384
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-4686
  • Fax:
Mailing address:
  • Phone: 509-474-4686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN60263992
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: