Healthcare Provider Details

I. General information

NPI: 1093107617
Provider Name (Legal Business Name): JENNA KOCHEVAR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA BORYS DO

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 W 5TH AVE STE 800
SPOKANE WA
99204-2912
US

IV. Provider business mailing address

PO BOX 5299 MS: 820-5-PCO
TACOMA WA
98415-0299
US

V. Phone/Fax

Practice location:
  • Phone: 509-755-5120
  • Fax: 509-755-6580
Mailing address:
  • Phone: 253-459-8231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number34.013532
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberOP61199682
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOP61199682
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: