Provider Demographics
NPI:1952147886
Name:HEALTHY LIVING PREMIER MEDICAL PLLC
Entity type:Organization
Organization Name:HEALTHY LIVING PREMIER MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-924-6199
Mailing Address - Street 1:1431 N LIBERTY LAKE RD STE A
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-8522
Mailing Address - Country:US
Mailing Address - Phone:509-928-6700
Mailing Address - Fax:
Practice Address - Street 1:1431 N LIBERTY LAKE RD STE A
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-8522
Practice Address - Country:US
Practice Address - Phone:509-928-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty