Provider Demographics
NPI:1962427880
Name:N.A.T.I.V.E. PROJECT
Entity type:Organization
Organization Name:N.A.T.I.V.E. PROJECT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:LODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-325-5502
Mailing Address - Street 1:1803 W MAXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2831
Mailing Address - Country:US
Mailing Address - Phone:509-325-5502
Mailing Address - Fax:509-483-9460
Practice Address - Street 1:505 E NORTH FOOTHILLS DR
Practice Address - Street 2:STE 300
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2101
Practice Address - Country:US
Practice Address - Phone:509-483-7535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAL0131351207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1104811033OtherNPI SANDRA FORSMAN
WA1306842596OtherNPI VINETTA MACPHERSON
WA1912996257OtherNPI CANDY JACKSON
WA1982600359OtherNPI KENDRA LONG
WA1912996257OtherNPI CANDY JACKSON