Healthcare Provider Details

I. General information

NPI: 1174125645
Provider Name (Legal Business Name): MAILEE MARIE BIRD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 N WALL ST
SPOKANE WA
99205-4600
US

IV. Provider business mailing address

650 W RAPTOR PEAK DR
SPOKANE WA
99224-5856
US

V. Phone/Fax

Practice location:
  • Phone: 509-868-0876
  • Fax:
Mailing address:
  • Phone: 509-294-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61103851
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: