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General NPI Number Information
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NPI Number | 1245767631
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Entity Type | Organization
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Legal Business Name | ERIC DUDENHOFER ARNP PS
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Dates
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Enumeration Date | 05/16/2017
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Last Update Date | 06/09/2019
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Provider Practice Location Address
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Address Line | 1271 HIGHLAND AVE # B
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City | CLARKSTON
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State | WA
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Zip | 99403-2846
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Country | US
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Telephone | 509-321-4590
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 193
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City | NINE MILE FALLS
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State | WA
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Zip | 99026-0193
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Country | US
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Telephone | 509-321-4590
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Fax | 509-321-4593
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | ERIC DUDENHOFER
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Credential | ARNP
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Telephone | 509-321-4590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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