Provider Demographics
NPI:1992463665
Name:SALAU, PHOEBE L
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:L
Last Name:SALAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12307 E 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-0387
Mailing Address - Country:US
Mailing Address - Phone:509-230-3869
Mailing Address - Fax:509-779-6069
Practice Address - Street 1:12307 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0387
Practice Address - Country:US
Practice Address - Phone:509-230-3869
Practice Address - Fax:509-779-6069
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA755071311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home