Individual
HERENA SIM RECORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
820 S MCCLELLAN ST STE 200, SPOKANE, WA 99204-2456
(509) 747-1144
(509) 227-7070
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
143187
FL
207R00000X
Internal Medicine Physician
Primary
MD61213125
WA
Other
Enumeration date
10/23/2006
Last updated
07/27/2022
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