MEDICARE: JANICE MARIE COURCHAINE 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
1	163W00000X	Registered Nurse	RN00163673	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	707219	OTHER	WA	PROVIDER NUMBER

General Provider Information

NPI Number	:	1518304997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE MARIE COURCHAINE RN

Provider Business Mailing Address
First Line	:	9527 E MISSION AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-4058
Country	:	US
Telephone Number	:	509-220-8786
Fax Number	:	509-279-2375

Provider Business Practice Location Address
First Line	:	9527 E MISSION AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-4058
Country	:	US
Telephone Number	:	509-220-8786
Fax Number	:	509-279-2375

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2013
Last Update Date	:	05/26/2013

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