Provider Demographics
NPI:1245235803
Name:NARKIEWICZ, MIRA G (MD)
Entity Type:Individual
Prefix:
First Name:MIRA
Middle Name:G
Last Name:NARKIEWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 E ROCKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-3312
Mailing Address - Country:US
Mailing Address - Phone:509-363-0616
Mailing Address - Fax:
Practice Address - Street 1:140 S ARTHUR ST
Practice Address - Street 2:STE 670
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2220
Practice Address - Country:US
Practice Address - Phone:509-462-4567
Practice Address - Fax:509-462-1162
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000337982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG29945Medicare UPIN