Healthcare Provider Details

I. General information

NPI: 1477793040
Provider Name (Legal Business Name): MITCH YARBROUGH HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 W CATALDO AVE
SPOKANE WA
99201-2217
US

IV. Provider business mailing address

217 W CATALDO AVE
SPOKANE WA
99201-2217
US

V. Phone/Fax

Practice location:
  • Phone: 509-624-2326
  • Fax: 509-789-5705
Mailing address:
  • Phone: 509-624-2326
  • Fax: 509-789-5705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA00003408
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: