Unknown Individual – Pediatric Nurse Practitioner, NPI 1306877196
Pediatric Nurse Practitioner
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Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
421, Liberty Lane, Evesham Township, Burlington County, New Jersey, 08053-5344, United States
LIBERTY LAKE, WA 990190421
Phone: (509) 747-3081
Fax: (509) 227-7070
Type: Mailing
1919, South Grand Boulevard, Manito / Cannon Hill, Spokane, Spokane County, Washington, 99203, United States
SPOKANE, WA 992032347
Phone: (509) 747-3081
Fax: (509) 227-7070
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 99019)
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