Healthcare Provider Details

I. General information

NPI: 1861128852
Provider Name (Legal Business Name): STEPHANIE DAWN DOUD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 E D ST
DEER PARK WA
99006-5167
US

IV. Provider business mailing address

816 W FRANCIS AVE PMB 146
SPOKANE WA
99205
US

V. Phone/Fax

Practice location:
  • Phone: 509-276-5005
  • Fax:
Mailing address:
  • Phone: 720-202-9495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number61330046
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP.AP.61330046
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60084144
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: