Individual
DR. DEBORAH ANN ICENOGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5011 W LOWELL AVE STE 100, SPOKANE, WA 99208-8587
(509) 299-1958
(509) 299-1070
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(509) 385-0610
(509) 227-7070
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD00028918
WA
208D00000X
General Practice Physician
MD00028918
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1120765
—
WA
Enumeration date
09/20/2006
Last updated
07/21/2022
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