Healthcare Provider Details

I. General information

NPI: 1265365043
Provider Name (Legal Business Name): DEANNA HEIDORN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W 5TH AVE
SPOKANE WA
99204-2803
US

IV. Provider business mailing address

4519 N SHIVA LN
SPOKANE WA
99212-8901
US

V. Phone/Fax

Practice location:
  • Phone: 208-791-5755
  • Fax:
Mailing address:
  • Phone: 208-791-5755
  • Fax: 208-791-5755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60857658
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: