Healthcare Provider Details

I. General information

NPI: 1841628070
Provider Name (Legal Business Name): ROCKWOOD CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2013
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 W 5TH AVE STE 300
SPOKANE WA
99204-2972
US

IV. Provider business mailing address

PO BOX 3649
SPOKANE WA
99220-3649
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-2531
  • Fax: 509-755-6580
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP60386230
License Number StateWA

VIII. Authorized Official

Name: SARRAH GLENNIE
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 509-342-3758