Healthcare Provider Details

I. General information

NPI: 1295500858
Provider Name (Legal Business Name): ALEXIS STEPHEN BROCK RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 E 8TH AVE
SPOKANE WA
99202-1201
US

IV. Provider business mailing address

19520 E KALAMA AVE
GREENACRES WA
99016-5304
US

V. Phone/Fax

Practice location:
  • Phone: 509-638-7426
  • Fax:
Mailing address:
  • Phone: 509-638-7426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberRN00157932
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: