Healthcare Provider Details

I. General information

NPI: 1114860103
Provider Name (Legal Business Name): CARDINAL SUPPORT WA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N HOWARD ST
SPOKANE WA
99201-0508
US

IV. Provider business mailing address

2804 S LAKEVIEW DR
CEDAR HILL TX
75104-8233
US

V. Phone/Fax

Practice location:
  • Phone: 817-898-7860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NWAMAKA LARVINE EMERUEM
Title or Position: OWNER
Credential:
Phone: 817-898-7860