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General NPI Number Information
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NPI Number | 1861218596
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Entity Type | Individual
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Provider Name | KAILYN MCKENZIE MENDEZ
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Gender | Female
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 12715 E MISSION AVE
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216-1027
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Country | US
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Telephone | 253-227-3802
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Fax |
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Provider Business Mailing Address
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Address Line | 15404 E SPRINGFIELD AVE
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City | SPOKANE VALLEY
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State | WA
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Zip | 99037-8569
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Country | US
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Telephone | 509-232-5766
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | RN61310718
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License Number State | WA
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