Healthcare Provider Details

I. General information

NPI: 1356575807
Provider Name (Legal Business Name): ASHLEY REBECCA WILSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 SE KING DRIVE
PULLMAN WA
99163
US

IV. Provider business mailing address

123 E. INDIANA AVE
SPOKANE WA
99207
US

V. Phone/Fax

Practice location:
  • Phone: 866-904-7721
  • Fax: 509-248-3644
Mailing address:
  • Phone: 866-904-7721
  • Fax: 509-452-0362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP60431795
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN2259457
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP60431795
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: