Healthcare Provider Details

I. General information

NPI: 1043706583
Provider Name (Legal Business Name): HEALTHY SCHOOLS WASHINGTON, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 WEST ROSEWOOD AVE
SPOKANE WA
99208
US

IV. Provider business mailing address

3546 SAINT JOHNS BLUFF RD S UNIT 113
JACKSONVILLE FL
32224-2714
US

V. Phone/Fax

Practice location:
  • Phone: 904-379-5997
  • Fax:
Mailing address:
  • Phone: 904-379-5997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL CATAUSAN
Title or Position: OWNER
Credential: MD
Phone: 904-379-5997