Healthcare Provider Details

I. General information

NPI: 1679006399
Provider Name (Legal Business Name): LICE EXPERTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8615 N DIVISION ST SUITE A
SPOKANE WA
99208-5945
US

IV. Provider business mailing address

8615 N DIVISION ST SUITE A
SPOKANE WA
99208-5945
US

V. Phone/Fax

Practice location:
  • Phone: 509-703-9290
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE REPP
Title or Position: MANAGER
Credential:
Phone: 509-703-9290