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General NPI Number Information
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NPI Number | 1245027309
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Entity Type | Organization
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Legal Business Name | KODIAK HEALTHCARE
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Dates
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Enumeration Date | 04/22/2025
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 8923 E EUCLID AVE
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City | MILLWOOD
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State | WA
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Zip | 99212-2048
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Country | US
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Telephone | 509-496-3066
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11742
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City | SPOKANE VALLEY
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State | WA
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Zip | 99211-1742
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Country | US
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Telephone | 509-496-3066
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARAH JOY MANFRED
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Credential | ARNP
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Telephone | 509-496-3066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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