Provider Demographics
NPI:1114919990
Name:BRISBANE, NANETTE M (OD)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:M
Last Name:BRISBANE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NANETTE
Other - Middle Name:M
Other - Last Name:BRISBANE-TURPIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:12209 E MISSION AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4824
Mailing Address - Country:US
Mailing Address - Phone:509-443-3145
Mailing Address - Fax:509-443-3968
Practice Address - Street 1:12209 E MISSION AVE STE 9
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4824
Practice Address - Country:US
Practice Address - Phone:509-443-3145
Practice Address - Fax:509-443-3968
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00002029152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1041461Medicaid
U71371Medicare UPIN
WAAB05170Medicare PIN