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General NPI Number Information
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NPI Number | 1780714139
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY NORTHWEST PLLC
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 530 S COWLEY ST STE 100
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City | SPOKANE
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State | WA
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Zip | 99202-1316
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Country | US
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Telephone | 509-838-7028
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Fax | 509-623-2177
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Provider Business Mailing Address
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Address Line | 530 S COWLEY ST STE 100
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City | SPOKANE
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State | WA
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Zip | 99202-1316
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Country | US
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Telephone | 509-838-7028
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Fax | 509-623-2177
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Authorized Official
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Title or Position | REVENUE CYCLE MANAGER
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Name | MRS. SANDRA CONNER
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Credential |
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Telephone | 509-321-4110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 00032173
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 00027337
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License Number State | WA
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