Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP60931419 | WA |
NPI | 1003386525 |
---|---|
Provider Name | Michael Colver |
First Address | Spokane, WA 99201-0254 |
Second Address | Spokane, WA 99205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2018 |
Last Update Date | 20/02/2019 |