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SPOKANE RIVER FAMILY WELLNESS, PLLC

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Company Details

Legal Name: SPOKANE RIVER FAMILY WELLNESS, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: December 23rd 2021
Expiration date: 31 Dec 2025
UBI Number: 604 848 289
ZIP code: 99206
City: Spokane
County: SPOKANE
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 915 N PINES RD, SPOKANE VLY, WA, 99206-4932, UNITED STATES

Contact Details

E-Mail: ALEXANDER.FULTZ@GMAIL.COM
Phone Number: +1 509-481-1378

Nature of Business

Any Lawful Purpose, Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
ALEXANDER FULTZ Registered Agent 915 N PINES RD, SPOKANE VLY, WA, 99206-4932, UNITED STATES

Key Officers & Management

Name Role Address
TERRI YOUNG Executor 13107 E 25TH AVE, SPOKANE VLY, WA, 99216-2516, UNITED STATES
ALEXANDER FULTZ Governing Person -
MIRIAM HALLIDAY Governing Person -

National Provider Identifier

NPI Number:
1477205680
Certification Date:
2022-01-19

Authorized Person:

Name:
TERRI LYNN YOUNG
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
163WL0100X - Lactation Consultant (Registered Nurse)
Is Primary:
No
Selected Taxonomy:
174N00000X - Lactation Consultant (Non-RN)
Is Primary:
No
Selected Taxonomy:
175F00000X - Naturopath
Is Primary:
No
Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
363LF0000X - Family Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
363LP0200X - Pediatric Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
363LX0001X - Obstetrics & Gynecology Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
367A00000X - Advanced Practice Midwife
Is Primary:
No
Selected Taxonomy:
176B00000X - Midwife
Is Primary:
Yes

Contacts:

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