Healthcare Provider Details

I. General information

NPI: 1316604473
Provider Name (Legal Business Name): GEORGE WANGAI PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N CALISPEL ST
SPOKANE WA
99201-2317
US

IV. Provider business mailing address

10510 E 20TH AVE
SPOKANE VALLEY WA
99206-3305
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-4651
  • Fax:
Mailing address:
  • Phone: 770-292-0854
  • Fax: 509-732-9970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61555499
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61095751
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: