| Spokane Resource Group, Pllc | |
|
1817 E Springfield Ave Suite E. Spokane WA 99202-2913 | |
| (509) 262-6406 | |
| (509) 262-6406 |
| Full Name | Spokane Resource Group, Pllc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1817 E Springfield Ave, Spokane, Washington |
| Authorized Official Name and Position | Troy Bruner (BUSINESS MANAGER) |
| Authorized Official Contact | 5092626406 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spokane Resource Group, Pllc 1817 E Springfield Ave Suite E. Spokane WA 99202-2913 Ph: (509) 262-6406 | Spokane Resource Group, Pllc 1817 E Springfield Ave Suite E. Spokane WA 99202-2913 Ph: (509) 262-6406 |
| NPI Number | 1013205483 |
|---|---|
| Provider Enumeration Date | 07/19/2011 |
| Last Update Date | 07/19/2011 |
| Medicare PECOS PAC ID | 6204097561 |
|---|---|
| Medicare Enrollment ID | O20120412000513 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013205483 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY60115733 (Washington) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | AP60211296 (Washington) | Primary |
| Provider Name | Susan K Bruner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376849737 PECOS PAC ID: 7719165604 Enrollment ID: I20110623000485 |
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