Provider Demographics
NPI:1073871646
Name:BOETEL, ANISHA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANISHA
Middle Name:MARIE
Last Name:BOETEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANISHA
Other - Middle Name:MARIE
Other - Last Name:BOETEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:SUITE 450E
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:509-474-6920
Practice Address - Fax:509-474-3014
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-94982084P0800X
WAMD606482132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry