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General NPI Number Information
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NPI Number | 1447058607
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Entity Type | Organization
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Legal Business Name | RENEWED HEALTH
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 14817 E 30TH AVE
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City | SPOKANE VALLEY
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State | WA
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Zip | 99037-8057
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Country | US
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Telephone | 509-599-4224
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Fax |
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Provider Business Mailing Address
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Address Line | 14817 E 30TH AVE
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City | SPOKANE VALLEY
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State | WA
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Zip | 99037-8057
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Country | US
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Telephone | 509-599-4224
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA L GROGAN
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Credential | ARNP
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Telephone | 509-599-2442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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