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NPI Code Detail

MEDICARE: STACI M HESTDALEN M.D.

MEDICARE: STACI M HESTDALEN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology PhysicianMD00043715WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194790006
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACI M HESTDALEN M.D.
Provider Business Mailing Address
First Line : 1807 N HUTCHINSON RD
Second Line :
City : SPOKANE VALLEY
State : WA
Zip : 99212-2444
Country : US
Telephone Number : 509-456-7414
Fax Number : 509-624-0763
Provider Business Practice Location Address
First Line : 1807 N HUTCHINSON RD
Second Line :
City : SPOKANE VALLEY
State : WA
Zip : 99212-2444
Country : US
Telephone Number : 509-456-7414
Fax Number : 509-624-0763
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2006
Last Update Date : 08/13/2019

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Directions to “ STACI M HESTDALEN M.D.” Practice Location

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