Healthcare Provider Details

I. General information

NPI: 1134064371
Provider Name (Legal Business Name): JESSE MATHWIG FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9106 W RUTTER PKWY
SPOKANE WA
99208-9210
US

IV. Provider business mailing address

6225 E VALLEYVIEW DR
SPOKANE VALLEY WA
99212-3276
US

V. Phone/Fax

Practice location:
  • Phone: 360-880-8193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number114827-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: