Healthcare Provider Details

I. General information

NPI: 1619705381
Provider Name (Legal Business Name): GKM HOLDING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 W BELT AVE STE 125
SPOKANE WA
99205
US

IV. Provider business mailing address

10518 N ALBERTA RD
SPOKANE WA
99208-4483
US

V. Phone/Fax

Practice location:
  • Phone: 509-808-2835
  • Fax:
Mailing address:
  • Phone: 509-808-2835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GEOFFREY MWANGI
Title or Position: OWNER
Credential: APRN
Phone: 509-808-2835