MEDICARE: ERIC DUDENHOFER ARNP PS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1245767631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIC DUDENHOFER ARNP PS

Provider Business Mailing Address
First Line	:	PO BOX 193
Second Line	:
City	:	NINE MILE FALLS
State	:	WA
Zip	:	99026-0193
Country	:	US
Telephone Number	:	509-321-4590
Fax Number	:	509-321-4593

Provider Business Practice Location Address
First Line	:	1271 HIGHLAND AVE # B
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-2846
Country	:	US
Telephone Number	:	509-321-4590
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	ERIC DUDENHOFER
Credential	:	ARNP
Telephone Number	:	509-321-4590

Provider Enumeration Date	:	05/16/2017
Last Update Date	:	06/09/2019

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