Healthcare Provider Details

I. General information

NPI: 1225027436
Provider Name (Legal Business Name): STEPHANIE ROSE MOLINE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ROSE PERRY M.D.

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR STE 130
COEUR D ALENE ID
83814-4404
US

IV. Provider business mailing address

PO BOX 3868
SPOKANE WA
99220-3868
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-4700
  • Fax: 208-625-4701
Mailing address:
  • Phone: 509-228-1000
  • Fax: 509-252-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number7761579
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD00041718
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: