Basic Information
| Provider Information | |||||||||
| NPI: | 1972697456 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIETHKE | ||||||||
| FirstName: | MARION | ||||||||
| MiddleName: | CLAIRE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4815 N ASSEMBLY ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992056185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094347000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4815 N ASSEMBLY ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094347006 | ||||||||
| FaxNumber: | 5094347115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD00026387 | WA | N | Other Service Providers | Specialist | 207N00000X | MD00026387 | WA | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.