Healthcare Provider Details

I. General information

NPI: 1336932508
Provider Name (Legal Business Name): MARISA KOLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 E SPRAGUE AVE STE H
SPOKANE WA
99202-4894
US

IV. Provider business mailing address

3608 E 20TH AVE
SPOKANE WA
99223-5409
US

V. Phone/Fax

Practice location:
  • Phone: 509-368-7556
  • Fax: 509-808-2267
Mailing address:
  • Phone: 509-368-7556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: