Individual
SHAD FLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
800 W 5TH AVE, SPOKANE, WA 99204-2803
(509) 458-5800
Mailing address
23225 E MAXWELL AVE, LIBERTY LAKE, WA 99019-8559
(661) 231-5443
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP61299457
WA
Other
Enumeration date
04/15/2019
Last updated
06/22/2022
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