Provider Demographics
NPI:1376691832
Name:CURALLI, NICK LAURENCE (DO)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:LAURENCE
Last Name:CURALLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1414 N VERCLER RD
Mailing Address - Street 2:BLDG 4
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1092
Mailing Address - Country:US
Mailing Address - Phone:509-924-4681
Mailing Address - Fax:509-922-7634
Practice Address - Street 1:1414 N VERCLER RD
Practice Address - Street 2:BLDG 4
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1092
Practice Address - Country:US
Practice Address - Phone:509-924-4681
Practice Address - Fax:509-922-7634
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001053207Q00000X
ID085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA87846OtherLABOR & INDUSTRY WASH
ID003626600OtherIDAHO MEDICAID
WA8000085Medicaid
000351501Medicare ID - Type Unspecified
WA8000085Medicaid