Icenogle, Deborah Ann

Icenogle, Deborah Ann is an individual health care provider with primary practice located at 5011 W Lowell Ave Ste 100 , Spokane WA 99208-8587. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / General Practice, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is her primary health care specialty. Icenogle, Deborah Ann can be contacted via phone (509) 299-1958.

Contact Information

Primary practice address
5011 W Lowell Ave Ste 100 Spokane WA 99208-8587
Phone: (509) 299-1958
Fax: (509) 299-1070
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X MD00028918 Washington
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD00028918 Washington

Profile Details

NPI number 1831296177
LBN Legal business name Icenogle, Deborah Ann
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2006
Last updated Jul 21st, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831296177 NPPES
Washington MEDICAID 1120765

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