Provider Demographics
NPI:1174125645
Name:BIRD, MAILEE MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:MAILEE
Middle Name:MARIE
Last Name:BIRD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W RAPTOR PEAK DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-5856
Mailing Address - Country:US
Mailing Address - Phone:509-294-1669
Mailing Address - Fax:
Practice Address - Street 1:1812 N WALL ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4600
Practice Address - Country:US
Practice Address - Phone:509-868-0876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61103851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily