Healthcare Provider Details

I. General information

NPI: 1033201199
Provider Name (Legal Business Name): MONRUDEE KOUTOUVIDIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 SOUTH YAKIMA AVE STE 110
TACOMA WA
98405
US

IV. Provider business mailing address

1708 SOUTH YAKIMA AVE STE 110
TACOMA WA
98405
US

V. Phone/Fax

Practice location:
  • Phone: 253-627-9151
  • Fax: 253-591-8892
Mailing address:
  • Phone: 253-627-9151
  • Fax: 253-591-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00123567
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30007448
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: