Healthcare Provider Details

I. General information

NPI: 1457346108
Provider Name (Legal Business Name): RANDI K OBRIEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 W MALLON AVE STE 503
SPOKANE WA
99201-2181
US

IV. Provider business mailing address

621 W MALLON AVE STE 503
SPOKANE WA
99201-2181
US

V. Phone/Fax

Practice location:
  • Phone: 509-455-5546
  • Fax: 509-455-5201
Mailing address:
  • Phone: 509-455-5546
  • Fax: 509-455-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP30006159
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: