Individual
MS. ENNESSA IVY GORKOVCHENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
217 W CATALDO AVE, SPOKANE, WA 99201-2217
(509) 747-6194
(509) 252-2837
Mailing address
PO BOX 2242, SPOKANE, WA 99210-2242
(509) 747-6194
(509) 252-2837
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60901681
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA60901681
DEPARTMENT OF HEALTH
WA
Enumeration date
11/21/2017
Last updated
09/28/2018
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