Healthcare Provider Details

I. General information

NPI: 1437330735
Provider Name (Legal Business Name): NORTH SPOKANE GYNECOLOGY AND COSMETIC LASER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E ROWAN AVE SUITE 109
SPOKANE WA
99207-1240
US

IV. Provider business mailing address

235 E ROWAN AVE SUITE 109
SPOKANE WA
99207-1240
US

V. Phone/Fax

Practice location:
  • Phone: 509-482-4313
  • Fax: 509-482-2918
Mailing address:
  • Phone: 509-482-4313
  • Fax: 509-482-2918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number025209 MD00020672
License Number StateWA

VIII. Authorized Official

Name: SUSAN J TEWEL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 509-482-4313