Healthcare Provider Details

I. General information

NPI: 1215200613
Provider Name (Legal Business Name): DEBORAH ELIZABETH MONAHAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH MONAHAN NP-C

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E HOLLAND AVE STE 100
SPOKANE WA
99218-1246
US

IV. Provider business mailing address

305 RIVER DR
LOLO MT
59847-8732
US

V. Phone/Fax

Practice location:
  • Phone: 509-228-1000
  • Fax: 509-252-9300
Mailing address:
  • Phone: 406-370-9376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-RN-LIC-24252
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61129129
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: