Provider Demographics
NPI:1912245333
Name:DUBIEL, KALISTA H (ARNP)
Entity Type:Individual
Prefix:
First Name:KALISTA
Middle Name:H
Last Name:DUBIEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 N VERCLER RD
Mailing Address - Street 2:BLDG 5
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1092
Mailing Address - Country:US
Mailing Address - Phone:509-385-0302
Mailing Address - Fax:509-385-0304
Practice Address - Street 1:1414 N VERCLER RD
Practice Address - Street 2:BLDG 5
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1092
Practice Address - Country:US
Practice Address - Phone:509-385-0302
Practice Address - Fax:509-385-0304
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60312436363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD2776815OtherDEA