Healthcare Provider Details

I. General information

NPI: 1235592015
Provider Name (Legal Business Name): KODI ALICIA-THERESA SHUMWAY NA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KODI ALICIA-THERESA RUTLEDGE NA

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3754 W INDIAN TRAIL RD
SPOKANE WA
99208-4736
US

IV. Provider business mailing address

3754 W INDIAN TRAIL RD
SPOKANE WA
99208-4736
US

V. Phone/Fax

Practice location:
  • Phone: 509-328-7041
  • Fax: 509-328-7582
Mailing address:
  • Phone: 509-328-7041
  • Fax: 509-328-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: