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General NPI Number Information
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NPI Number | 1912632746
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Entity Type | Individual
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Provider Name | JAIMIE RYAN
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Gender | Female
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Dates
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Enumeration Date | 07/16/2022
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 101 W 8TH AVE
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City | SPOKANE
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State | WA
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Zip | 99204-2307
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Country | US
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Telephone | 509-474-3260
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 421
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-0421
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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 |
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN60433496
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP61338067
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP61338067
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License Number State | WA
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