Healthcare Provider Details

I. General information

NPI: 1083889893
Provider Name (Legal Business Name): RIVERSIDE HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 N MILLER ST SUITE 1B
WENATCHEE WA
98801-6604
US

IV. Provider business mailing address

819 N MILLER ST SUITE 1B
WENATCHEE WA
98801-6604
US

V. Phone/Fax

Practice location:
  • Phone: 509-888-1924
  • Fax: 509-888-2238
Mailing address:
  • Phone: 509-888-1924
  • Fax: 509-888-2238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateWA

VIII. Authorized Official

Name: STACY R STUBBLEFIELD
Title or Position: OWNER
Credential: CNM/ARNP
Phone: 509-421-5077