Individual
SANDRA L. FORNWALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
101 W 8TH AVE, SUITE 1100, SPOKANE, WA 99204-2307
(509) 474-4060
(509) 474-6198
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
MD00049202
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
407023200
—
MD
Enumeration date
06/24/2005
Last updated
05/18/2021
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