Healthcare Provider Details

I. General information

NPI: 1639400500
Provider Name (Legal Business Name): TAMA ROSE BOGERT A.A.S.-H.I.S. #4369
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2010
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9502 N NEWPORT HWY SUITE 2
SPOKANE WA
99218-1147
US

IV. Provider business mailing address

4016 W PRINCETON AVE
SPOKANE WA
99205-1861
US

V. Phone/Fax

Practice location:
  • Phone: 509-465-2243
  • Fax: 509-465-2269
Mailing address:
  • Phone: 509-327-5045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number4369
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: