1447269923 NPI number — NATHANIEL VAN VALIN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447269923 NPI number — NATHANIEL VAN VALIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATHANIEL VAN VALIN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447269923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1925 N HARMONY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE VALLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99016-8418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-570-6133
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15425 E MISSION AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99037-9505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-924-7010
Provider Business Practice Location Address Fax Number:
509-924-7532
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VAN VALIN
Authorized Official First Name:
NATHANIEL
Authorized Official Middle Name:
ASHBY
Authorized Official Title or Position:
PHYSICIAN ASSISTANT
Authorized Official Telephone Number:
509-924-7010

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA10004910 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PA10004910 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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