Individual
SHANA COLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
105 W 8TH AVE, SUITE 200, SPOKANE, WA 99204-2302
(509) 624-9112
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60596888
WA
Other
Enumeration date
01/09/2014
Last updated
10/12/2015
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