Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH00002228 | WA |
NPI | 1982689287 |
---|---|
Provider Name | Mr. Kevin L. Henning |
First Address | Colbert, WA 99005-9097 |
Second Address | Spokane, WA 99218-3412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 26/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T02468 | (02) |