Healthcare Provider Details

I. General information

NPI: 1518787019
Provider Name (Legal Business Name): JACQUELINE M NERO-DOUGLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 N DIVISION ST # 1234
SPOKANE WA
99207-1411
US

IV. Provider business mailing address

816 W FRANCIS AVE # 472
SPOKANE WA
99205-6512
US

V. Phone/Fax

Practice location:
  • Phone: 209-390-3350
  • Fax:
Mailing address:
  • Phone: 209-390-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: