Healthcare Provider Details

I. General information

NPI: 1255984894
Provider Name (Legal Business Name): DYLAN MICHAEL WARD BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S FREYA ST GREEN BLDG, STE 212
SPOKANE WA
99202
US

IV. Provider business mailing address

2910 E 57TH AVE SUITE 5 #126
SPOKANE WA
99223-1510
US

V. Phone/Fax

Practice location:
  • Phone: 509-557-0450
  • Fax: 509-757-8981
Mailing address:
  • Phone: 509-557-0450
  • Fax: 509-363-2762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61421441
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60765414
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: