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NPI Code Detail

MEDICARE: BREANNA MEKALAH COLVIN RN

MEDICARE: BREANNA MEKALAH COLVIN RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse5771245ID

General Provider Information

NPI Number : 1184568552
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANNA MEKALAH COLVIN RN
Provider Business Mailing Address
First Line : 611 N IRON BRIDGE WAY
Second Line :
City : SPOKANE
State : WA
Zip : 99202-4905
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1203 IDAHO ST
Second Line :
City : LEWISTON
State : ID
Zip : 83501-1940
Country : US
Telephone Number : 509-444-8200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2026
Last Update Date : 04/16/2026

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