Healthcare Provider Details

I. General information

NPI: 1508426032
Provider Name (Legal Business Name): NICHOLAS GRAHAM CYSEWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W 5TH AVE
SPOKANE WA
99204-2803
US

IV. Provider business mailing address

PO BOX 28510
SPOKANE WA
99228-8510
US

V. Phone/Fax

Practice location:
  • Phone: 509-603-5800
  • Fax:
Mailing address:
  • Phone: 253-263-7114
  • Fax: 253-263-7115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD61279632
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: