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General NPI Number Information
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NPI Number | 1548851645
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Entity Type | Individual
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Provider Name | MR. BRIAN MATTHEW STOUT
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Gender | Male
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Dates
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Enumeration Date | 02/01/2021
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Last Update Date | 02/01/2021
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Provider Practice Location Address
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Address Line | 18306 71ST AVE E
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City | PUYALLUP
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State | WA
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Zip | 98375-1843
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Country | US
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Telephone | 931-538-2387
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Fax |
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Provider Business Mailing Address
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Address Line | 18306 71ST AVE E
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City | PUYALLUP
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State | WA
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Zip | 98375-1843
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Country | US
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Telephone | 931-538-2387
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | LP60534434
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License Number State | WA
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