# WANDERMERE OCCUPATIONAL MEDICINE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295114346
- **Authorized official:** DANIEL J DEPNER PA-C (CLINIC DIRECTOR)
- **Authorized official phone:** (509) 879-0039

## Contact information

- **Practice address:** 309 E FARWELL RD, SUITE204, SPOKANE, WA 99218-8210
- **Practice address phone:** (509) 720-7452
- **Practice address fax:** (509) 466-4798
- **Mailing address:** 5011 W ALCOTT CT, SPOKANE, WA 99208-9141
- **Mailing address phone:** (509) 879-0039
- **Mailing address fax:** (509) 466-4798

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QX0100X | Occupational Medicine Clinic/Center | PA10001774 | WA | Yes |

## Other

- **Enumeration date:** 05/22/2015
- **Last updated:** 10/26/2015