Healthcare Provider Details

I. General information

NPI: 1649539487
Provider Name (Legal Business Name): CARRIE LESLIE CORWIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE LESLIE GRAVES M.D.

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE STE 100L-1
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

PO BOX 421
LIBERTY LAKE WA
99019-0421
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-2880
  • Fax: 509-227-7070
Mailing address:
  • Phone: 509-474-2880
  • Fax: 509-227-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberMD60852457
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: