Provider Demographics
NPI:1154982569
Name:MEZENGIE, FAYE G
Entity type:Individual
Prefix:
First Name:FAYE
Middle Name:G
Last Name:MEZENGIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12314 E 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-0323
Mailing Address - Country:US
Mailing Address - Phone:206-596-6742
Mailing Address - Fax:509-474-0178
Practice Address - Street 1:12314 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0323
Practice Address - Country:US
Practice Address - Phone:206-596-6742
Practice Address - Fax:509-474-0178
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60289346163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse