Basic Information
Provider Information | |||||||||
NPI: | 1528220159 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | READHEAD | ||||||||
FirstName: | HEATHER | ||||||||
MiddleName: | TINDALL | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD, MPH | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | TINDALL | ||||||||
OtherFirstName: | HEATHER | ||||||||
OtherMiddleName: | C.A. | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD MPH | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 421 | ||||||||
Address2: |   | ||||||||
City: | LIBERTY LAKE | ||||||||
State: | WA | ||||||||
PostalCode: | 990190421 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5094742072 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1212 N PINES RD | ||||||||
Address2: |   | ||||||||
City: | SPOKANE VALLEY | ||||||||
State: | WA | ||||||||
PostalCode: | 992064939 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5098938140 | ||||||||
FaxNumber: | 5092277070 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/25/2008 | ||||||||
LastUpdateDate: | 09/02/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 254167 | NY | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | A116217 | CA | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | MD60535689 | WA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.