Provider Demographics
NPI:1730888421
Name:MCCOY, MAIA TENEA (RN)
Entity type:Individual
Prefix:
First Name:MAIA
Middle Name:TENEA
Last Name:MCCOY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MAIA
Other - Middle Name:TENEA
Other - Last Name:MCCOY MATTHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6325 N MONROE ST # 48253
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4119
Mailing Address - Country:US
Mailing Address - Phone:253-350-3297
Mailing Address - Fax:
Practice Address - Street 1:6517 N STEVENS ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4006
Practice Address - Country:US
Practice Address - Phone:253-350-3297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61113017163WC0400X, 163WC1500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse