Liberty Lake Direct Primary Care PLLC
Family Medicine in Liberty Lake, WA. Organization (NPI-2).
NPI number1558048280
StatusActive
Last updated in NPPESJul 4, 2023
Details
- NPI
- 1558048280
- Entity type
- Organization (NPI-2)
- Legal business name
- Liberty Lake Direct Primary Care PLLC
- Organization subpart
- No
- Enumeration date
- Jul 4, 2023
- Certification date
- Jul 4, 2023
- Last updated
- Jul 4, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Other names
- Liberty Lake Dpc (Doing Business As)
Practice location
2207 N Molter RdLiberty Lake, WA 99019-7570
Phone 509-348-2214
Mailing address
704 N Madson CtLiberty Lake, WA 99019-7507
Phone 509-828-5250
Authorized official
Jared W. Nelson
Owner
5098285250
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