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General NPI Number Information
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NPI Number | 1730986035
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Entity Type | Organization
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Legal Business Name | HRT EVERGREEN PC
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 11917 E BROADWAY AVE STE 102
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City | SPOKANE VALLEY
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State | WA
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Zip | 99206-6011
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Country | US
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Telephone | 602-796-2559
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Fax |
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Provider Business Mailing Address
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Address Line | 10501 W GOWAN RD STE 200
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City | LAS VEGAS
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State | NV
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Zip | 89129-6602
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS OPERATIONS DIRECTOR
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Name | AMANDA WILKINSON
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Credential |
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Telephone | 602-796-2559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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