Provider Demographics
NPI:1255984894
Name:WARD, DYLAN MICHAEL (BSN)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:MICHAEL
Last Name:WARD
Suffix:
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 E 57TH AVE SUITE 5 #126
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-1510
Mailing Address - Country:US
Mailing Address - Phone:509-557-0450
Mailing Address - Fax:509-363-2762
Practice Address - Street 1:104 S FREYA ST
Practice Address - Street 2:GREEN BLDG, STE 212
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:509-557-0450
Practice Address - Fax:509-757-8981
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60765414163W00000X
WAAP61421441363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse