Healthcare Provider Details

I. General information

NPI: 1457094575
Provider Name (Legal Business Name): LA LUNE INTEGRATIVE PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2022
Last Update Date: 04/16/2022
Certification Date: 04/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 W RIVERSIDE AVE STE 4117
SPOKANE WA
99201-0580
US

IV. Provider business mailing address

522 W RIVERSIDE AVE STE 4117
SPOKANE WA
99201-0580
US

V. Phone/Fax

Practice location:
  • Phone: 206-531-7844
  • Fax: 503-386-3252
Mailing address:
  • Phone: 206-531-7844
  • Fax: 503-386-3252

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: MS. ELITA WONG
Title or Position: OWNER, NURSE PRACTITIONER
Credential: NP
Phone: 206-531-7844