Healthcare Provider Details

I. General information

NPI: 1427274547
Provider Name (Legal Business Name): CAROL O'DEAN GALES REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL O'DEAN SHERLING REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W SPRAGUE AVE
SPOKANE WA
99201-3627
US

IV. Provider business mailing address

210 W SPAGUE AVE
SPOKANE WA
99201-3816
US

V. Phone/Fax

Practice location:
  • Phone: 509-343-5045
  • Fax: 509-747-0609
Mailing address:
  • Phone: 509-343-5045
  • Fax: 509-747-0609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN00071145
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: