MEDICARE: MRS. BRENDA M STOUDT ARNP

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	208000000X	Pediatrics Physician	30007859	WA
2	363LP2300X	Primary Care Nurse Practitioner	AP30007859	WA

General Provider Information

NPI Number	:	1295996494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA M STOUDT ARNP

Provider Business Mailing Address
First Line	:	9705 W NELSON DR
Second Line	:
City	:	NINE MILE FALLS
State	:	WA
Zip	:	99026-8651
Country	:	US
Telephone Number	:	509-230-3914
Fax Number	:	509-464-6959

Provider Business Practice Location Address
First Line	:	1717 W FRANCIS AVE STE 104
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99205-6858
Country	:	US
Telephone Number	:	509-230-3914
Fax Number	:	509-464-6959

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	01/24/2024

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