Provider Demographics
NPI:1457958530
Name:METTA WELLNESS NW PLLC
Entity type:Organization
Organization Name:METTA WELLNESS NW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDAN
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:TENNEFOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,AGPCNP-BC,ACHPN
Authorized Official - Phone:509-639-3394
Mailing Address - Street 1:904 W RIVERSIDE AVE UNIT 1107
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99210-0329
Mailing Address - Country:US
Mailing Address - Phone:509-255-3527
Mailing Address - Fax:858-947-2017
Practice Address - Street 1:904 W RIVERSIDE AVE UNIT 1107
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99210-0329
Practice Address - Country:US
Practice Address - Phone:509-255-3527
Practice Address - Fax:858-947-2017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1528571130OtherNPI
OR201803923OtherNURSE PRACTITIONER LICENSE
OR201709029OtherNURSE PRACTITIONER LICENSE
1184127169OtherNPI