Provider Demographics
NPI:1639864374
Name:AIRWAY PEDIATRICS, PROFESSIONAL LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:AIRWAY PEDIATRICS, PROFESSIONAL LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-328-2477
Mailing Address - Street 1:808 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122-9434
Mailing Address - Country:US
Mailing Address - Phone:702-328-2477
Mailing Address - Fax:509-461-5287
Practice Address - Street 1:10408 W SUNSET HWY STE 3
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-6002
Practice Address - Country:US
Practice Address - Phone:702-328-2477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty