MEDICARE: INCLUSA HEALTH AND WELLNESS PLLC

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	207VB0002X	Obesity Medicine (Obstetrics & Gynecology) Physician

General Provider Information

NPI Number	:	1891464905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INCLUSA HEALTH AND WELLNESS PLLC

Provider Business Mailing Address
First Line	:	21600 E MERIWETHER LN
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-7629
Country	:	US
Telephone Number	:	208-755-6731
Fax Number	:

Provider Business Practice Location Address
First Line	:	23403 E MISSION AVE STE 231
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-5087
Country	:	US
Telephone Number	:	509-367-4209
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. STEPHANIE PERSONDEK
Credential	:	DO
Telephone Number	:	208-755-6731

Provider Enumeration Date	:	09/10/2021
Last Update Date	:	07/17/2025

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