Healthcare Provider Details

I. General information

NPI: 1407557820
Provider Name (Legal Business Name): SHELBY STOEBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 W BROADWAY AVE
SPOKANE WA
99201-2119
US

IV. Provider business mailing address

2603 W FAIRVIEW AVE
SPOKANE WA
99205-3837
US

V. Phone/Fax

Practice location:
  • Phone: 509-622-5600
  • Fax:
Mailing address:
  • Phone: 253-527-3501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN61049744
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: