Healthcare Provider Details

I. General information

NPI: 1982060539
Provider Name (Legal Business Name): ANDREW JOHN DAVID BINGHAM BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 S REGAL ST
SPOKANE WA
99223
US

IV. Provider business mailing address

4202 S REGAL ST
SPOKANE WA
99223-7738
US

V. Phone/Fax

Practice location:
  • Phone: 360-789-3587
  • Fax: 509-789-3780
Mailing address:
  • Phone: 360-789-3587
  • Fax: 509-789-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNC60554663
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: