Healthcare Provider Details

I. General information

NPI: 1689316796
Provider Name (Legal Business Name): TAREYN LYN GOSSLER-GREEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAREYN GREEN PA

II. Dates (important events)

Enumeration Date: 04/09/2022
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 E 29TH AVE STE 100
SPOKANE WA
99223-4868
US

IV. Provider business mailing address

2002 W PULLMAN RD
MOSCOW ID
83843-4012
US

V. Phone/Fax

Practice location:
  • Phone: 509-724-4320
  • Fax:
Mailing address:
  • Phone: 208-883-8372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-2364
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: